
Book J2 2, 4— 



Gopigta'N?._ 



CDMRIGHT nEPOSJT. 



//S7 



Contrtbittioit0 



American Jttebual ^SBoriatton 



Contribute to tire Juram §toital Association. 



ESSAYS 



SECRETORY AND THE EXCITOSECRETORY 
SYSTEM OF NERVES 



IN THEIR RELATIONS TO 



PHYSIOLOGY AND PATHOLOGY. 



COMPRISING 

1. A NEW CLASSIFICATION OF FEBRILE DISEASES. 

II. AN EXPOSITION OF THE "GANGLIONIC PATHOLOGY" OF ALL CONTINUED FEVEPiS, AS 
ILLUSTRATED IN TYPHUS AND TYPHOID FEYER. 

III. THE PRIZE ESSAY ON THE EXCITO- SECRETORY SYSTEM OF NERYES IN ITS RELATIONS 

TO PHYSIOLOGY AND PATHOLOGY. 

IV. A LETTER TO DR. MARSHALL HALL, OF LONDON, CLAIMING PRIORITY IN THE DIS- 

COVERY AND NAMING OF THE EXCITO-SECRETORY SYSTEM OF NERVES. 



HENRY ERASER CAMPBELL, A.M., M.D.,' 

ONE OF THE VICE-PRESIDENTS OF THE AMERICAN MEDICAL ASSOCIATION, AND PROFESSOR OF SPECIAL 
AND COMPARATIVE ANATOMY IN THE MEDICAL COLLEGE OF GEORGIA (AUGUSTA). 



WITH ILLUSTRATIONS. 



fb* 



PHILADELPHIA: 

B. LIPPINCOTT AND CO 
1857. 



n- 



^ 







^ 



ft! 



Entered according to the Act of Congress, in the year 1857, by 

J. B. LIPPINCOTT & CO., 

in the Clerk's Office of the District Conrt of the United States in and for the 
Eastern District of Pennsylvania. 



TO 

MARSHALL HALL, M.D.,F.R.S., 

MEMBER OP THE INSTITUTE OF FRANCE, 

AND 

AUTHOR OF THAT GRAND INDUCTION OF MODERN PHYSIOLOGY, "THE PRINCIPLE 

OP REFLEX NERVOUS ACTION," 



is dMhciiott 0f <&mi% 



THE SECRETORY AND THE E X C I T O-S E C R E T R Y SYSTEM, 



IS RESPECTFULLY INSCRIBED, 



IN HIGH ADMIRATION OF HIS GENIUS, 



HEARTFELT ACKNOWLEDGMENT OF HIS LIBERALITY, 



THE AUTHOR, 



PREFACE 



The several papers composing the following little volume were 
on different occasions presented as reports to the American Medical 
Association, and, with the exception of the Letter to Dr. Marshall 
Hall, will be found published in the Transactions of that body. 
They have, at least most of them, been distributed privately to 
various distinguished members of the profession in pamphlet form. 
Their scattered condition, as they exist in the volumes of the 
Transactions, and the proverbially perishable nature of pamphlet 
literature, have induced us to bring in the close relation of a single 
volume, our several papers on the Nervous System, which appear 
to us to have a special relation to one another, in order that we 
may gain for our views before the reader that advantage which will 
accrue from a simple juxtaposition and an uninterrupted reading. 

One of the most distinguished essayists 1 of modern times has 
remarked, that "the rarest works are frequently the most original; 
for precisely in proportion as an author is in advance of his age, is 
it likely that his works will be neglected ; and the neglect of con- 
temporaries, in general, consigns a book, especially a small book, if 
not protected by accidental concomitants, at once to the tobacconist 
or tallow-chandler. This is more particularly the case with pam- 
phlets." The same writer here instances the neglect sustained by 
the philosophical pamphlet of Arthur Collier, which, though long 
antecedent and far more original than the large volume of Bishop 
Berkeley, yet sank into oblivion, because it was a pamphlet and 

1 Sir William Hamilton. 



Vlll PREFACE. 

not a volume. It is to save our pamphlet on "Typhoidal Fevers," 
•which we humbly hope contains at least the germ of the truth in 
regard to the pathology of this class of fevers, from the fate of 
passing into the department of " Forgotten Literature," that we now 
make it a part of a system, which admits of a board-bound volume 
for its elaboration. 

The Letter to Dr. Marshall Hall, contains all of our earlier pub- 
lications on the excito-secretory system, and we have therefore 
withheld the separate introduction of those papers in the present 
volume. This letter will be found also to contain the previous 
claim of priority made before the American Medical Association, 
on the announcement of Mons. C. Bernard in 1853. At the time 
of its publication, one or two of our friends said, that we but ex- 
pressed views which they themselves had entertained in an indefi- 
nite form for years. Mr. Carlyle gives utterance to an idea which 
fully explains this general recognition of original views as things 
not altogether unfamiliar. It is something like this : that at a time 
immediately preceding every discovery in science or art, there are 
vague, detached, elementary portions of it floating through the brains 
of many, who, having only parts of the truth, but partly express it, 
or do not express it at all, or are not sufficiently convinced of the 
truth to proclaim it boldly, 1 but still it has become somewhat 

1 " That man is not the discoverer of any art who first says the thing ; but he 
who says it so long, and so loud, and so clearly, that he compels mankind to hear 
him — the man who is so deeply impressed with the importance of the discovery 
that he will take no denial, but, at the risk of fortune and fame, pushes through 
all opposition, and is determined that what he thinks he has discovered shall not 
perish for want of a fair trial." — See Tyler Smith on Parturition. 

The following, which comes to us while these pages are undergoing correction, is 
found in an obituary notice of Dr. Marshall Hall, and the very diction indicates 
who the author is. Here is the penetrating insight of the Philosopher yoked with 
the sprightly gleaming of the Poet. It is from the glowing pen of Dr. Oliver 
Wendell Holmes. In referring to Dr. Hall's discovery of Reflex action — Excito- 
motory action, and the disputations following its announcement by him, this writer 
uses the following striking language : — 

" Others may have more or less perfectly observed and announced some of the 
facts in the series of demonstrations. But they spoke in a whisper or in a corner, 



PREFACE. IX 

familiar to many, so that when he who is justly entitled to be 
called the originator of the system announces it, " What he says," 
to use the author's own language, " all men were not far from 
saying — indeed, were longing to say. The thoughts of all start up, 
as from painful, enchanted sleep, round his thought, answering to 
it, 'Yes, even so!' We all feel as if we could, and some feel as if 
we did, fashion such a result. The built house seems all so fit, 
every way as it should be — as if it came there by its own law and 
the nature of things — that we forget the rude, disorderly quarry it 
was shaped from. The very perfection of the house, as if nature 
herself had made it, hides the builder's merit." We claim no great 
perfection for our work, nor merit for ourself, except the merit of 
originality already fully accorded us. We know that " the excito- 
secretory system will," as Dr. Marshall Hall says, " require many 
laborers and many years for its perfection." We claim no other 
merit, because it was to an incident of our early youth 1 that we 
owe the direction given to our mind which led to the result, how- 
ever important it may have since proved and may yet prove. It 
is far from being, as yet, a " built house," but we claim to have, at 
least, been the first who fitted the materials and showed how they 
were to be put together. 

The classification of febrile diseases found in the introduction 
to this volume, we sincerely believe to be the true one, and with 
truth for its basis, we do not hesitate to predict that, in time, it 
must become the accepted one. 

We will make one remark about the prize essay near the end of 
this collection, and then close our rather lengthy preface. It will 

and when they had once spoken, were quiet. He cried his doctrine and its proofs 
aloud in the street and in the academy ; he shouted it over and over again, until 
he was hoarse with calling ; he printed it in little pamphlets and big books ; he 
dressed it in Italics and capitals, as if it were an incendiary proclamation ; he 
wearied the very echoes with it, until at last the deaf and surly world took up its 
ear-trumpet and listened — and lo ! one of the startling truths that make a century 
luminous in the procession of time/and lift a withered student into planetary re- 
putation!" — Boston Med. and Surg. Journal. 
1 See note, p. 130. 



X PREFACE. 

doubtless appear to some readers, that we have given the motto of 
the essay too much prominence in the discussion ; where such is 
the opinion, we can only express our regret that we feel obliged to 
differ. The motto of this essay was intended by us, rather as a 
principal theme for discussion, equal in importance with the pro- 
fessed subject itself, than as, simply a motto; hence it will be found 
that a large portion of the paper, while it does not overlook the 
development of the excito-secretory system, is yet earnestly devoted 
to illustrating the fallacy of experiment when not properly governed 
by correct observation and reasoning ; while, on the other hand, we 
have endeavored to illustrate the great value of many observations 
where no experiment, in the technical sense, has been made, claiming 
for the observation at least equal value with the experiment when 
applied to the purposes of induction. " Observation is a lens which 
collects the distant rays of the past into a focus upon the present, 
that it may consume the false or kindle into higher life the true" 1 

These remarks have been thus far prolonged, from the desire, on 
our part, to give to these essays, written on different subjects and 
at long intervals, that "oneness" which, in our opinion, a volume 
should ever present. And notwithstanding all our care, we feel 
constrained, in conclusion, to use the apt language of another, 2 " we 
are sensible that we have not disposed our materials to abide the 
test of captious controversy, but of a sober and even forgiving 
examination ; that they are not armed at all points for battle, but 
dressed to visit those who are willing to give a peaceful entrance 
to truth." 

Augusta, Ga., July, 1857. 

1 Bidwell's Eclectic Magazine. 

2 Edmund Burke. On the Sublime and Beautiful. 



CONTENTS 



PA.GE 

I. The Classification of Febrile Diseases by their relation to the 

Nervous System xiii 

II. An Inquiry into the Nature of Typhoidal Fevers, based upon 

a consideration of their History and Pathology . . 23 

III. Prize Essay — The Excito -Secretory System of Nerves ; its 

relations to Physiology and Pathology . . . . 61 

TV. Letter to Dr. Marshall Hall — A claim of Priority in the Dis- 
covery and Naming of the Excito -Secretory System of 
Nerves 109 

Y. Note Conclusory 133 



I. 



THE NERVOUS SYSTEM 



FEBRILE DISEASES 



INTRODUCTION TO ESSAY ON TYPHOIDAL FEVERS. 



THE CLASSIFICATION OF FEBRILE DISEASES BY THEIR 
RELATION TO THE NERVOUS SYSTEM. 1 

During the examination of our subject since the time of our 
appointment as a special committee, by this Association, we have 
been, at each step, more and more impressed with its importance, 
and at the same time with the extreme difficulty attending its full, 
clear, and thorough elaboration. "A man," says Lord Bacon, 
" must collect facts, in order to know the law of facts;" diligently 
and earnestly engaged for the year past, in collecting and interro- 
gating the facts which have a bearing on the important subject of 
Febrile Diseases, in the relation assigned us for examination, we 
have scarcely had time to do more than note, here and there, the 
gleam of truth which has been evolved during a bare hasty collo- 
cation of data; much less to determine satisfactorily any fixed law 
in relation to the vast subjects involved in the investigation. That 
such laws will be recognized, and that the careful generalization of 
the facts will be productive of important, fruitful results, we have 
already seen enough fully to persuade us. Pleading then the 
magnitude, as well as the embarrassments of the subject, we ask of 
this Association the privilege of having our special committee con- 
tinued for another year, allowing us at present to lay before this 
body a few conclusions arrived at, as the result of the investigation 
in its presest state of progress. 

I. As all the normal phenomena of the living organism are 
known to occur under the superintending influence of the nervous 
system, and are dominated by it, so it is but rational to regard all 
morbid actions as being more or less influenced in their manifesta- 

1 See " Partial Report on the Nervous System in Febrile Diseases." Trans. Amer. 
Med. Association, Vol. X. 



XVI PAETIAL REPORT ON 

tions by aberrated nervous action. In that class of diseases ordina- 
rily designated fevers, our researches and observations have led us 
to the confident belief that the above law applies with sufficient 
prominence to constitute the basis of their classification, and we 
would here respectfully claim for it, that it is the only reliable basis 
of their classification, and further, that in its more extended appli- 
cation, it will hereafter be found to constitute what may be called 
par excellence, the Law of Febrile Diseases. Simply to assert the 
recognition of this law, and to suggest a new and more comprehen- 
sive classification of Fevers based upon it, is the sole object of the 
present brief exposition. 

II. As in the Nervous System, we recognize two grand depart- 
ments, viz: 1st. The Cerebro-spinal System, all the normal actions 
of which are subject to cessations and interruptions; and, 2dly. 
The Ganglionic System, all the normal actions of which are of a 
continuous and uninterrupted character, so in the manifestations of 
febrile diseases, do we distinctly recognize two grand distinguish- 
ing characteristics respectively typifying the normal actions of 
these two systems of nerves : thus, a character of paroxysm obtains 
in certain cases, while a character of continuousness as plainly marks 
the others. 

III. Again : as in the Cerebro-spinal System, we find that its 
normal action pertains almost exclusively to sensation and to mo- 
tion, with only a secondary and comparatively somewhat remote 
influence (which we have termed Excito-Secretory) upon nutrition 
and secretion, while in the normal action of the Ganglionic System 
the entire function is known to be, to preside over nutrition and 
the secretions ; so in paroxysmal fevers do we find intense pain, 
modified sensation, and symptoms allying them to neuralgic and 
convulsive diseases very prominent, while in continued fevers, mo- 
dified nutrition and altered secretion, are the marked and most 
prominent characteristics. We would, therefore, announce as our 
classification of febrile diseases, two grand divisions of fevers 
corresponding with the two grand divisions of the nervous sys- 
tem, thus: — 

I. Cerebro-spinal Fevers. 

All Paroxysmal. The secretions and nutrition only secondarily 
affected. 

II, Ganglionic Fevers. 

All Continued. The secretions and nutrition primarily affected. 



THE NERVOUS SYSTEM IN FEBRILE DISEASES. XV11 

I. Under the head of Cerebro-spinal Fevers, we would place 
the whole family of Paroxysmal Fevers, whatever type they may 
assume, 1 and, also, the various forms of neuralgia, which are nearly 
always intermittent, as well as the sthenic forms of Traumatic Fever, 
together with the Fever accompanying simple Pharyngitis, Pneu- 
monitis, Dysentery, 2 and many other diseases of malarial districts. 

II. Under the head of Ganglionic Fevers, or Fevers of the 
Secretory System of Nerves, we think that we rind ample 
ground for bringing together many diseases heretofore widely 
estranged from each other. Thus, as the archetypal form of gan- 
glionic fevers, we place at the head of the list, typhus and typhoid 
fever, 3 then, allied to these in various degrees of affinity, but all 
equally, in the one essential element, that they present themselves as 
manifestations of disease through the Ganglionic System, are variola, 
scarlatina, 4 rubeola, varicella, and many other forms of eruptive 
fevers, heretofore not classified by nosologists. All of these last 
diseases are marked by fever of a continued or non-paroxysmal 
character, all present marked aberrations of nutrition and secretion, 
and each has its own peculiar eruptive character; and, further, 
each one is definitely self-limited in its duration, as yet, no remedial 
interference having been found competent to arrest or shorten their 
progress. 

We will here make the remark, that we do not wish to be mis- 
taken as classifying these diseases in relation to their eruptive fea- 

1 The primitive location of these fevers, in the cerebrospinal system, was de- 
veloped by Prof. L. D. Ford, of the Medical College of Georgia, in the Southern 
Medical and Surgical Journal, in 1836, and called by Maillot, " Cerebro-spinal In- 
termittent Irritations." 

2 See Clinical Lectures at Jackson Street Hospital " On the Pathology and Treat- 
ment of Dysentery, by Robert Campbell, M. D., Demonstrator of Anatomy in the 
Medical College of Georgia." In these Lectures the relation of Dysentery to 
Paroxysmal Fever is fully considered by my brother. 

3 As first developed in an essay entitled : "An Inquiry into the Nature of Typhoidal 
Fevers, based upon a Consideration of their History and Pathology, " presented to the 
American Medical Association, at its Session of May, 1853, by Henry F. Campbell, 
Chairman of Committee on Typhoid Fever. The implication of the ganglionic 
system of nerves, in typhus and typhoid fever, has been, in the above essay, 
argued at length. We would now assert — that Asiatic Cholera and its kindred 
diseases present a class of symptoms which pre-eminently manifest that the ulti- 
mate location of these affections is in the Ganglionic or Secretory system of nerves. 

4 M. Trousseau, in his recent Lectures on Scarlatina, seems to take a similar 
view. He says : " The ganglionary system is implicated." 

B 



XV111 PARTIAL REPORT ON 

ture, but only as signifying a recognition of the common influence 
of the secretory system of nerves in all of them by the eruption. 
In typhoid fever itself, it must be recollected that the eruption is not 
a prominent feature, and yet, we consider the secretory system of 
nerves primarily deeply affected, and place this at the head of the 
list, notwithstanding the fact, that the ganglionic implication mani- 
fests itself hut little upon the skin and mainly in the intestinal 
canal. 1 

It may be asked, if all of these fevers are due to aberration in 
the innervation of the ganglionic or secretory system of nerves, 
why should they present such marked specific differences? A 
satisfactory answer may be given thus : that specificity of morbific 
cause must rationally be expected to secure a specificity of morbid 
manifestation ; thus, the virus of variola, when taken into the sys- 
tem, gives rise to the morbid manifestations peculiar to smallpox, 
while the morbific influence (of whatever nature it may be) of 
typhoid fever, produces a specific form of disease entirely different, 
but not the less for that reason, locatable in parts of the organism 
entirely controlled by the secretory nervous system. 

Blending of Types of Fever. — Much interest has been taken 
by this Association, for the last five years, in the subject of the 
Blending of the Types of Fever. We would claim, for the present 
Pathology and Classification of Fevers, that it is the only one which 
admits of any plausible explanation of the mysterious phenomena 
comprehended under the term, "Blending of Types;" thus, a cere- 
brospinal or paroxysmal fever may assume, under certain circum- 
stances, some of the characteristics of some one or other of the 
forms of continued fever. This, we hold, can be explained by attri- 
buting it to a propagation of the irritation, originally located in 
the spinal marrow, to the ganglia of the secretory system. Then, 
again, the reverse may obtain; we may find, and do often find, in 
continued fevers, especially in malarious districts (whether the case 
be typhoid fever, rubeola, or scarlatina), intermittent paroxysms, 
interrupting the even course of the continued form, sometimes ob- 
scuring the diagnosis, and making it necessary to modify the 
treatment. The use of quinine, it is well known, will generally 
break up these paroxysms, but not in the least modify the course of 
the continued fever. In the first of these cases, the morbific influ- 
ence has been "centripetal" and in the second "centrifugal," and 

1 See Inquiry, &c, pp. 53 and 54. 



THE NERVOUS SYSTEM IN" FEBRILE DISEASES. xix 

thus the "blending of types" may be rationally and philosophi- 
cally explained. 

We are aware that, in presenting thus a condensed exposition on 
the obscure subject of " The Nervous System in Febrile Diseases," 
without more argument and fuller elaboration, we are running the 
risk of being charged with "bare assertion," but we will honestly 
avow, that each proposition has been earnestly and carefully consi- 
dered, keeping constantly in view all the phenomena of febrile 
diseases — comparing them faithfully with the normal actions of 
the two grand departments of the nervous system. 

It will be remarked, that we have not attempted to define what 
is the exact morbid condition of the nervous centres, or of the 
nerves, which gives rise to the phenomena in the two classes of 
fever. Such a process of reasoning we have carefully abstained 
from, because such a discussion would be conversant about sub- 
jects which cannot as yet be said to have been brought within the 
legitimate domain of science. "We can only as yet trace the effects 
to their causes; it is a different thing to discuss the nature of the 
causes themselves ; and as Professor Whewell has made a distinc- 
tion between the Laics of Phenomena and the Causes of Phenomena, 
so we only here claim to have recognized a Law, leaving the more 
recondite inquisition into the Causes, for a more advanced and en- 
lightened age of science. In conclusion, we will say, we may have 
been, in the above exposition, unfortunately obscure in presenting 
to others what has become a clear and well defined conviction to 
us; but in the pertinent language of another, 1 whose deep philoso- 
phy has charmed us, while it has been of unspeakable service to us 
in many of our investigations, we will say, that " to our mind this 
doctrine stands firm and impregnable — assailable by no known fact 
consistent with every established truth." 

1 Dr. M'Cosh, on the Method of the Divine Government. 



II. 



AN INClUIRY 



NATURE OF TYPHOIDAL FEVERS 



AN INQUIKY 



NATURE OF TYPHOIDAL FEVERS. 



BASED UPON A CONSIDERATION OF 



THEIR HISTORY AND PATHOLOGY, 



AND ILLUSTRATING 



THE GANGLIONIC PATHOLOGY OF ALL CONTINUED FEVERS. 



To this confidence I have come, not merely through the convictions of my 
own consciousness, but from finding in this system, a centre and concilia- 
tion for the most opposite of philosophical opinions. — Hamilton. 



PRESENTED TO THE AMERICAN MEDICAL ASSOCIATION, 
AT ITS SESSION OF MAY, 1853. 



ERRATA IN ESSAY ON TYPHOIDAL FEVERS. 



Page 37, line 16, for " and that," read " or that." 

Page 50, line 32, for " opposite," read " apposite." 

Page 55, line 19, for "internal," read "intimate." 

Page 56, line 14, for "Pathology ," read "pathological Anatomy." 

Page 58, line 26, for " action," read " section." 

Page 58, line 29, for " a normal action," read "abnormal action." 



AN INQUIRY 



NATURE OF TYPHOIDAL FEVERS 



Ax analysis of the symptoms of typhoid fever, with a view to its 
correct pathology, is embarrassed by the difficulty which presents 
itself in the selection of those phenomena and events which are 
really characteristic of the disease; for in the immense body of re- 
corded observations with which the investigator is presented, there 
are comparatively but few which belong essentially to typhoid fever. 
In the following paper, it has been our object to give a brief but 
careful summary of its most prominent features, illustrating them 
when necessary by cases from the latest and most approved au- 
thorities, from a consideration of which our deductions have been 
made. 

We have in no instance referred to our own observations of cases, 
for it is obvious to our mind that any views of disease founded mainly 
\upon rational induction, would be less liable to fallacy, when based 
on the recorded, careful observations of others, than when they are 
merely the interpretation of our own cases, always liable to precon- 
ceived opinions and foregone conclusions, which have ever proved 
most effectual and deplorable barriers to correct observation. It is 
true that, in the plan here adopted, the same objection to a great 
extent will be found to exist ; but by this method we are freed 
from the fallacies which would be apt to arise from a personal 
record, with a view to establish a doctrine, and will have to con- 
tend only witH those which must necessarily attach to the interpre- 
tation of data, the record of which has in many instances been 
intended to corroborate views entirely dissimilar and often opposed 
to our own. 



b AN INQUIRY INTO THE 

Typhoid fever has prevailed so widely and oftentimes with such 
great fatality that there are few diseases which have excited such 
general interest with the etiologist and pathologist. Its symptoms 
and phenomena have been repeatedly noted with the utmost accuracy, 
and the recorder of the present day must bound his aspirations, and 
be content, by simply verifying the observations of those who have 
preceded him. But with the analyst the case is far different; 
being in search of no new phenomenon, not professing to add any- 
thing to what are already cognate facts, in relation to the disease, 
his object being merely to interpret these facts from data founded 
upon them, repeated observation and record by others but strengthen 
and confirm his positions, and afford him a wider field and more 
abundant material from which to draw his conclusions. 

History. — There are certain traits upon which nearly all writers 
have agreed as being usually characteristic of typhoid fever. In 
the first place there is always more or less prostration, with an im- 
pairment of the functions of the nervous system. Secondly, there 
is fever, which is continuous, but sometimes variable in its degree. 
Thirdly, in the vast majority of cases there is more or less diarrhoea, 
generally of an obstinate but passive character ; and fourthly, its 
most constant pathological appearances have been found to be those 
which refer to the abdominal viscera, there being very uniformly 
some special alteration in the follicles studding principally the mu- 
cous membrane of the mesenteric portion of the intestinal canal 
known as the glands of Peyer and Brunner. 

In addition to the above, which may be considered as almost es- 
sential characteristics of the disease, there are a great variety of 
symptoms described by almost every author as very constantly at- 
tendant upon it, and by many considered among its essential attributes. 
These, although very numerous, will be found generally more or less 
referable to one or other of three classes of symptoms, the combi- 
nation of which appears to constitute the disease, viz. disturbances 
of the nervous system, of the circulation, and of the digestive organs 
— and so far as practicable, we will thus classify them in our sum- 
mary. The symptoms pertaining to the cerebro spinal system, com- 
monly denominated the nervous symptoms of typhoid fever, consist 
in wandering pains in various parts of the body ; cephalalgia, pain 
in the back, loins, and extremities, more or less delirium, vigilance, 
somnolence, dulness of hearing, impaired vision, soreness of the mus- 



NATURE OF TYPHOIDAL FEVERS. 7 

cles, and occasionally subsultus tendinum, together with prostration 
of muscular power. 

In relation to this class of symptoms our reference to statistics 
has been attended with various results ; we find that they have 
generally been noted with a view to institute comparisons between 
the two types, typhoid and typhus, and the general result in regard 
to them, so far as we have been able to notice, has been ; that nerv- 
ous symptoms of one or other character are present in a large pro- 
portion of typhoid cases, but they do not generally form such promi- 
nent features in this as in the typhus type, where their existence is 
almost invariable, and of a character much more alarming ; so that, of 
the two diseases, the common term "nervous fever" would be more 
applicable to typhus. 

Disturbances of the Circulation are perhaps the most in- 
variably present of the three classes of symptoms. Of these, we 
will notice the abnormal states of the pulse, abnormal temperature 
of the skin, and the capillary congestions frequently observed on the 
surface of the body. 

The pulse is almost invariably more or less accelerated in both 
typhoid and typhus fever. In character, it is irritable, weak, and 
nervous, showing a remarkable contrast to the full, open, sthenic 
pulse, characterizing the paroxysms of periodic fever. Its fre- 
quency is far less than in the latter case, but it is nearly uniform ; 
and although occasionally subject to variations, this general feature 
of unintermitting continuousness is so constant, that it is from this 
probably more than from any other feature that these types have 
acquired the general name of continued fever. The average mean 
of the pulse, according to the accurate observations of Dr. Flint, is 
95. T J in typhoid cases, while it was found by him to be 105. f in 
the typhus type, which I think will be found not to vary materially 
from the observations of others. His tables also show that irregu- 
larity and feebleness are much more common in typhus than in ty- 
phoid fever. 

In relation to frequency he remarks : " There can be no doubt, if 
the pulse exceeds 120, except for a transient period, that the case is 
of dangerous severity ; and the danger increases in more than geo- 
metrical ratio, if it rises above this point." 

Temperature of Surface. — There is, as in other forms of fever, 
more or less heat of surface, in continued fever, which varies from a 



8 AN INQUIRY INTO THE 

little above tlie natural warmth to what is known technically as biting 
heat, color mordax ; but these aberrations are so common in every 
form of fever, that we cannot attach much importance to them in a 
pathological inquiry like the present. 

Sweating and Moisture, we find more common in typhoid than 
in typhus fever. In the former, cases vary much in regard to these 
symptoms ; sometimes the skin will remain usually dry, having at 
intervals sudden profuse exudations of sweat, soon becoming dry 
again. In other cases, the surface will be kept in a soft and gentle 
moisture during the whole disease ; while, again, the most profuse 
colliquative sweats will shrivel the surface and rapidly exhaust the 
strength of the patient. Upon the whole, there is a greater tend- 
ency to moisture than to dryness of surface in typhoid fever; 
while in the typhus type, decidedly the reverse is found to ob- 
tain. 

" It would be interesting," says Dr. Flint, " to acertain upon what 
ulterior conditions sweating is dependent. With reference to this 
point of inquiry, it would be important to establish any relations 
subsisting between this event and other phenomena belonging to the 
natural history of the disease. I have examined the histories of 
several of the cases characterized by sweating, in order to discover 
a clue to some connection of this kind, but without success. It oc- 
curs not only at different periods of the disease, but apparently ir- 
respective of the circulation, the temperature of the skin, and other 
symptoms. The antecedent morbid condition or conditions upon 
which it depends, and the circumstances involved in its production 
are unknown. All that can be said of its causation is, that it is an 
event incident to the progress of continued fever, belonging in the 
category with other incidental events, such as acceleration of the 
pulse, coating of the tongue, somnolency, &c, all of which are not 
more rationally explicable than it." 

Capillary Congestions. — Among the ordinary appearances of 
continued fever, there is no one which will strike the attention of the 
clinical observer more forcibly than the peculiar, diffused congestions 
on various parts of the cutaneous surface; and though the symptom 
is easily recalled to our minds by a bare mention of it, yet strange to 
say, it has been almost uniformly omitted by reporters until quite 
recently. Even Louis, with all his vigilance, seems to have allowed 



NATURE OF TYPHOIDAL FEVERS. 9 

this symptom to escape his attention. Dr. Gerhard, of Philadel- 
phia, appears to have made the earliest and most distinct reference 
to it, in his account of the epidemic typhus fever, in Philadel- 
phia, in 1836. Published in the American Journal of Medical 
Sciences, and also in Graves s and Gerhard's Glinical Medicine. 

"A constant symptom," says Dr. G., "observed in every case of 
typhus fever, was a dull livid red hue of countenance, extending 
nearly over its whole surface. Sometimes this colour approached 
a purple. It coincided with a strong, dark red suffusion of the ca- 
pillary vessels of the conjunctiva, which appeared at the same time 
with it ; but it usually disappeared at an earlier stage than the injec- 
tion of the eyes. The conjunctiva never presented the bright tinge 
or the brilliant aspect observed in acute inflammatory diseases of the 
brain, or eye itself." 

Dr. William Jenner, of University College, London, has also 
given recently his observations on this subject, in his work on 
typhus and typhoid fever. He remarks : " The conjunctivae were 
more or less intensely injected in twenty-five cases ; and in all of 
those in which the opportunity occurred of observing the date of the 
first appearance of the increased vascularity, it began during the 
second week. * * * In eleven of the cases the pupils were 
contracted. The expression was dull, and the bloodvessels had a 
dark red tinge, instead of their scarlet hue. The suffusion of the 
face and eyes was so constant and so well marked, in the fully formed 
disease, that it served almost as a pathognomonic sign. It was gene- 
rally most evident in patients of a full habit of body. Towards the 
close of the disease, the leaden colour was gradually changed into a 
dull ashen tint, which remained until the entire recovery of the pa- 
tient. The colour of the face when flushed (in typhus) was dusky 
red, and never pink as the cheeks were in cases of typhoid fever." 

But it is to Dr. Austin Flint, to whose admirably accurate and 
faithful reports we have already referred, and upon which we must 
continue to draw for reliable data in this inquiry, that is due the 
credit of the fullest statistical account of this trait of the typhoid 
affection. 

Inasmuch as we consider this symptom, as well as his observations 
in relation to it, somewhat important to the establishment of the 
views we have taken in regard to the pathology of the disease, we 
will give them somewhat in extenso. He remarks that these 
alterations of colour were evidently due to capillary congestion. 
They were always more marked on the cheeks than elsewhere, and 
2 



10 AN INQUIRY INTO THE 

sometimes were chiefly observable in that situation. In many in- 
stances, they extended entirely over the body. He describes the red- 
ness of the face as resembling closely the appearance which the sur- 
face presents after exposure to cold, the explanation probably being 
the same in either instance, viz : " retarded circulation of the blood 
in the capillary vessels."* On pressure with the finger, the redness 
disappears, and returns when the pressure is removed. The redness 
returned less quickly in proportion to its lividity or duskiness, show- 
ing that the colour is an indication of the degree in which the forces 
of the circulation residing in the capillary system are depressed. 

In the two types of continued fever, Dr. Flint found this symptom 
to differ very much; being much more frequent in the typhus 
type than in the typhoid, and also of a much darker and more 
livid hue in the former. In typhoid, it was seldom more than red, 
whereas in typhus, it was more frequently dusky or even livid than 
otherwise ; showing that, whatever cause acted in its production, this 
cause existed in greater force in typhus than in typhoid fever. 

" It may be suspected," remarks Dr. F., " that the capillary con- 
gestion of the face and surface generally, is dependent on the com- 
plication of pulmonary disease, in consequence of which, the free 
transmission of the blood through the lungs is prevented, and its 
aeration compromised. With reference to this point, I have com- 
pared the pulmonary symptoms with the symptoms now under con- 
sideration, in all the cases, and find that this connection does not 
uniformly exist. Several of the cases in which the congestive red- 
ness and dusky tint of the face was marked, presented pneumonic 
complication, denoted by cough and expectoration, accelerated respi- 
ration, and occasionally by the physical signs of inflammation of the 
lungs ; but these symptoms and signs were absent in other cases in 
which the appearances of the face were the same ; and the lungs 
evinced notable disorder and inflammation in cases in which no ca- 
pillary congestion is recorded in the notes. To speak with greater 
exactness of the cases of typhus, congestive redness of the face 
and marked disturbance of the respiration were associated in nine 
cases. The congestive redness was present without notable disturbed 
respiration in two cases. 

" Thus it appears that the condition of the capillaries is not attri- 
butable to the morbid condition of the lungs, or to derangement of 
the functional activity of these latter organs. It is worthy of note, 

* Austin Flint's First Report, p. 29. 



NATURE OF TYPHOIDAL FEVERS. 11 

however, that in typhus, in a large proportion of cases, capillary 
congestion is associated with pulmonary affection ; while in typhoid 
the absence of such a connection appears to be the rule. It is highly 
probable that both pulmonary disorder and congestion of the sur- 
face, may be the effects of the same prior morbid condition. It is 
not likely that the capillary congestion in continued fever is limited 
to the surface when it is present in the latter situation. Internal 
parts, could they be observed, might be expected to present similar 
appearances. The lungs, as is well ascertained, are liable to become 
congested during the febrile career, and the form of pneumonitis 
which usually occurs as a complication of this fever, called pseudo 
pneumonitis, is usually supposed to result chiefly from the passive 
engorgement of these organs. This complication, however, is thought 
to be far more liable to occur in typhus than in typhoid fever. The 
morbid condition, then, whatever it may be, which determines the 
congestive redness of the skin is the occasion of congestions else- 
where. ... In congestions pervading the capillary system of 
the general circulation, the lungs are especially prone to become in- 
volved. This is probably the fact in cases of typhoid as well as 
typhus, in which congestive redness of the surface is observed, but 
not in a degree sufficient, generally, to lead to a notable pulmonary 
complication or marked disorder of the respiration. The latter con- 
sequence, it would be expected, should much oftener be present in 
typhus, inasmuch as in this type, not only is capillary congestion pre- 
sent in a much larger number Qf cases, but it exists in a much greater 
degree." 

Conjunctival Redness. — Very nearly allied to capillary con- 
gestions of the general cutaneous surface of the body are those of 
the conjunctiva and other external mucous surfaces — and indeed by 
many they are classed with them, as occurring at the same time and 
apparently as a part of the same set of symptoms. Dr. Flint, how- 
ever, has shown by his records that congestions and suffusions of the 
conjunctiva are by no means always associated with those of the 
general surface, but occur independent of them : " not only capillary 
congestion of the skin does not exist in all cases of congestive ap- 
pearance of the conjunctiva, but the latter may be absent in cases 
in which the former is present." He farther remarks that this does 
not depend on cephalalgia. This, however, does not prove that they 
may not both be the effects of the same pathological condition — 



12 AN INQUIRY INTO THE 

circumstances ivhich ive are not able to appreciate occasioning the 
manifestation of either exclusive of the other. 

After a careful estimate of his cases and their various features 
under comparison, Dr. Flint inquires what is probably the prior con- 
dition upon which these two congestions in common depend, or in 
other words, what is the common proximate cause ? He considers 
that it depends upon the morbid condition of the blood itself, and 
does not relate to the state of the nervo-muscular forces influencing 
its circulation in the capillary vessels. In strict accordance with his 
excellent statistical method, he reasons thus from the fact, that if 
the cause resided in the vessels and not in the blood, inasmuch as 
the " pulse is the thermometer of the forces presiding over the gene- 
ral circulation," we should expect to find the circulatory forces com- 
promised by the disease in proportion as the pulse was found feeble, 
weak, and irregular; but as his records have been attended with a 
different result, hence his conclusion varies from what would at first 
appear most rational. It will be our duty, a little later in this in- 
quiry, to refer again to these views, and to endeavour to ascertain 
whether the present state of our knowledge of the physiology of the 
capillary circulation, will not relieve us from the necessity of regard- 
ing the condition of the heart's action as only the arbitrary criterion 
of the capillary circulation. 

Cutaneous Eruptions. — This class of symptoms being present 
in both the typhoid and typhus types of continued fevers, but under 
entirely different forms, it will be found convenient for the purposes 
of our analysis to institute a comparison of their prevailing charac- 
ters in the two diseases. It will be found on reference to authors, 
that they very generally agree that in the majority of cases of 
typhoid fever, there is an eruption characterized by well-defined 
spots of a rose colour, varying in size from that of a pin-head to a 
quarter of an inch in diameter. Louis observed them in twenty-six 
out of thirty-six of his fatal cases,* and Dr. Jackson's observations, 
in the Massachusetts General Hospital, have been attended with 
similar results, viz. about two-thirds of the cases presented the 
eruption. f Dr. Hale, as quoted by Dr. Bartlett, found the rose 

* Louis, Researches on Typhoid Fever. 

| In passing, we -would make the remark, though of course it has no bearing upon 
the object of this inquiry, that, according to our observations and those of many phy- 
sicians with whom we have conferred in relation to the eruption of typhoid fever, in 
those cases which occur in the Southern and Middle States, even where the disease 



NATURE OF TYPHOIDAL FEVERS. 13 

spots in one hundred and seventy-seven out of one hundred and 
ninety-seven cases. Dr. Flint reports thirty-seven out of forty-eight 
cases in private and hospital practice. His description of the eruption 
is as follows : "It is generally limited to the chest and abdomen, but 
occasionally extends to the extremities. It may be copious, particu- 
larly over the chest and abdomen, but oftener it is the reverse, the 
spots being few in number. The eruption is of a rose-red colour 
(rose spots, taches roses), the spots are oval, appearing somewhat 
elevated. The redness momentarily disappearing on pressure." 

In Dr. Jenner's description, we shall perhaps find all that is neces- 
sary to characterize this concomitant of typhoid fever: "The spots 
were slightly elevated. To detect the elevation, the finger had to 
be passed very delicately over the surface, as they had none of the 
hardness of the papulae of lichen or of the first day's eruption of 
smallpox. Their apices were never acuminated, never flat, but in- 
variably rounded, their bases gradually passing into the level of the 
surrounding cuticle. * * * They were circular, and of a bright 
rose-colour, the latter fading insensibly into the natural hue of the 
skin around. They never possessed a well-defined margin. They 
disappeared completely on pressure, resuming their characteristic 
appearances as soon as the pressure was removed ; and this was true 
from first to last, from their first eruption to their last trace. They 
left no stain of the cuticle behind; they never passed into anything 
resembling petechise ; the characters they presented on their first 
appearance continued till they vanished. Their ordinary size was 
about a line in diameter, but occasionally they were not more 
than half a line, and sometimes a line and a half. The duration 
of each papule was three or four days ; fresh papulae made their 
appearance every day or two. Sometimes only one or two were pre- 
sent at first, ran through the whole course described, and then one 
or more fresh ones made their appearance and vanished in three or 
four days, and were followed by others to last as long. The num- 
ber of papulae seen at one time on the surface was ordinarily from 
six to twenty ; though occasionally there was only one, and some- 
times more than a hundred." 

has prevailed as an epidemic, these eruptions are very rarely observable, although 
looked for with the utmost diligence throughout every stage of the disease. This ab- 
sence of eruption in cases where every other symptom characteristic of typhoid fever 
was present, has been so uniform that many of our most intelligent practitioners 
have been disposed to doubt the diagnostic importance of eruptions in typhoid fever, 
and to look upon them as of accidental occurrence, not having any important connec- 
tion with the true pathology of the disease. 



14 AN INQUIRY INTO THE 

" They usually occupied the abdomen, thorax, and back, but were 
occasionally present on the extremities. * * * -* A very pale deli- 
cate scarlet tint of the skin sometimes preceded the eruption of the 
papulae, but never lasted more than a day or two ; the skin resem- 
bling in tint that of a person shortly after leaving a hot bath. Rose- 
spots occurred in nineteen of the twenty-three fatal cases here ana- 
lyzed."* 

The typhus type of continued fever has been so uniformly charac- 
terized by cutaneous eruptions, that it is very often, even at the pre- 
sent day, classed among the eruptive fevers. Many of its synonymes 
indicate the frequency of this concomitant ; viz., exanthematic ty- 
phus, spotted fever, maculated fever, petechial fever, &c, &c. And 
while, on the one hand, we find authors disagreeing in relation 
to the importance of an eruption in the typhoid type, they very 
uniformly, where the opportunities have been sufficient for exten- 
sive observation, agree as to the eruption of typhus being one 
of its pretty constant, indeed almost uniform, concomitants. Dr. 
Gerhard says : " It was present in thirty-two out of thirty-six whites. 
Of the four cases in which it was not visible, one died on the seventh 
day of the disease, and the others presented only slight symptoms of 
fever, which disappeared in four or five days. It was also visible, 
though less distinctly, in mulattoes, and we may infer that the colour 
of the skin alone prevented its appearance in the negroes." 

In all of Dr. Jenner's fatal cases of typhus, forty-three in number, 
"the mulberry-rash," as he termed it, was present. 

According to Dr. Bartlett, the eruption differs, in many respects, 
in a striking degree from that of typhoid fever. Its colour, espe- 
cially after the second or third day of its appearance, is that of a 
duller or darker red. The spots are of a dun, dusky purplish hue ; 
in some cases they become almost black. They vary in size from 
that of a minute point to a line, or even to an eighth of an 
inch. They are less regularly circular or oval than the rose-spots of 
typhoid fever. They are not elevated above the surrounding surface, 
and disappear but very partially, or not at all, on pressure. They 
are, almost always, much more numerous than the rose-spots of ty- 
phoid fever, covering in many cases the entire trunk and extremities. 
Sometimes they are spread almost as thickly as the eruption of mea- 
sles, f 

By Pringle, these spots are referred to in the following words : 

* Jenner on Typhoid and Typhus Fevers. ' f Treatise on Fever, p. 220. 



NATURE OF TYPHOIDAL FEVERS. 15 

" There are certain spots which are the frequent, but not invariable 
attendants upon the fever in its worst state. They are of the pete- 
chial kind, of an obscure-red colour, paler than the measles, not 
raised above the skin, of no regular shape, but confluent. The 
nearer the spots approach the purple colour, the more ominous they 
are, though not absolutely mortal." Dr. Stewart (as quoted by Dr. 
Bartlett) says the rash is permanent, and does not, like that of ty- 
phoid fever, come out in successive eruptions ; that it, in all cases, 
presents the two periods of increase and decline, and that in the 
more severe cases it may exhibit, during the period of increase, four 
different states — florid, dark, livid, and petechial. "When the hue of 
the eruption is florid, it' readily disappears under pressure ; when 
dark, it still disappears, but more slowly ; when livid, semi-petechial, 
or pseudo-petechial, it is only partially effaced ; and when petechial, 
it is not in the least affected by pressure. Dr. Henderson, of Edin- 
burgh, has also noticed, that the progress and development of the 
eruption corresponded with the severity of the other symptoms of 
the disease, and that the decline of the eruption was nearly simulta- 
neous with the first symptoms of convalescence ; and, that the mor- 
tality and duration of the disease were in a very remarkable corre- 
spondence with the abundance of the eruption. 

Dr. Jenner describes three stages, through which these spots pass 
from their commencement to their perfection — he calls them the mul- 
berry-rash peculiar to typhus fever ; says they are never papular; that 
each spot is slightly elevated, and of a dusky-pink colour, flattened on 
the surface, with no well-defined margin, but irregular in outline, and 
in this stage it disappears completely on pressure. Size, from a mere 
point to three or four lines in diameter. In two or three days they 
become darker and more dingy than on their first appearance, and 
now they only fade on pressure, but do not disappear. In the 
third stage they become dark purple, and remain unaltered by 
pressure, although their circumferences still fade. Sometimes they 
are changed into true petechia, or spots presenting the following 
characters : "A dusky crimson or purple colour, quite unaffected by 
pressure ; a well-defined margin, and total want of elevation above 
the level of the cuticle." 

Dr. Clymer, in his work on fever, thus describes these spots : — 
" Their resemblance to flea-bites is such, that on the one hand the 
latter are often mistaken for petechia, while on the other hand some 
physicians will insist that real petechise are nothing else but flea- 
bites. The two appearances, however, cannot be mistaken by a care- 



16 AN INQUIRY INTO THE 

ful observer, &c. Sometimes the petechias are few in number, and 
escape notice ; in other instances, on the contrary, they are very 
much crowded. This appearance is owing to a thin stratum of extra- 
vasation on the surface of the true skin, and appears connected with in- 
creased force (?) of the circulating system, being most characteristic 
when reaction is high." 

It will be observed that we have classed in our summary both the 
capillary congestions, and those of the surface, and the various erup- 
tions incident to continued fever, under the common head of aberrations 
of the circulatory system ; and although this has not been the order in 
which we have usually found them considered by authors, we have 
still retained it, inasmuch as we regard these two classes of pheno- 
mena as dependent upon causes very similar, if, indeed, not identical 
in their nature, viz. : Impairment of the nervous forces, from which 
the capillary system of the surface obtains its functional endowments. 
That the capillaries possess a nervous motive power, independent, 
and not in all cases correspondent with the heart's action, many facts 
both in experimental physiology and in pathology would go to corrobo- 
rate. The exact nature and source of the nervous power are subjects 
foreign to the present part of our inquiry, and we therefore forbear 
here to discuss them. 

On making a comparison of the cutaneous congestions and erup- 
tions occurring in these two forms of continued fever, the following 
seems to be the result of our analysis of the foregoing summary of 
the observations and opinions of our best authors : — 

Firstly. That both capillary congestions and eruptions of one or 
other kind are present on the cutaneous surface in the vast majority 
of the cases in both the typhoid and typhus type of continued fever. 

Secondly. That these phenomena are more characteristic of ty- 
phus than of typhoid fever. 

Thirdly. That those of typhoid fever are of a less serious cha- 
racter — more nearly resembling the healthy action of the capillaries 
than those of typhus, as evinced in the congestions, by the more 
florid and natural colour of the surface ; showing that the blood, al- 
though circulating abnormally, still retains nearly its proper amount 
of oxygen — 4. e. its retardation is not so great as in the typhus type, 
when the congested surface is "dark," "purple," "livid," and 
" dusky," " resembling in appearance the cutaneous surface when its 
circulation is retarded from exposure to cold.* In the eruptions, 

* Dr. Flint's First Report on Continued Fever. 



NATURE OF TYPHOIDAL FEVERS. 17 

the same kind of attributes indicate that the aberration is of a less 
serious nature in typhoid than in typhus — the spots are very few in 
number, and often absent altogether, very rarely extending to the 
extremities ; they are simply of a reddish or pink colour, which 
readily disappears on pressure, returning when the pressure is re- 
moved ; while in typhus fever they are very numerous, generally ap- 
pearing on the extremities as well as on the body ; they not only 
arrive at the stage of simple congestion, but they go beyond that 
point, do not yield to pressure, and, finally, after a continuance of 
some days they become true petechias,* regular hemorrhagic spots, 
evidencing extravasation, f and, of course, a certain degree of disor- 
ganization in the vessels. J Again — If we look at the character of 
the two eruptions in another light, the same opinion of their relative 
gravity must obtain ; the typhoid papula is an elevated object on the 
surface of the skin — the elevation is the result of an elimination from 
the blood, caused by a hind of inflammation, which is always a phe- 
nomenon occurring under vital influences : this pseudo-inflammatory 
process subsides by effusion, and one crop of papulae is succeeded by 
another, which observes the same course, till the recovery or death 
of the patient ; but in the typhous petechise these phenomena are 
absent, or, at least, only present on the first or second day, for they 
soon give place to others which are the evidence of more serious ob- 
struction, and which are of such a character that their occurrence 
does not necessarily imply vitality in the parts wherein they occur. 
Thus we may say that, in typhoid fever, the redness of surface gene- 
rally, and the eruption, may be termed true congestion, while the 

* Dr. Stewart, as quoted by Dr. Bartlett. Also Jenner, on Typhoid and Typhus 
Fevers. 

f Clymer on Fever. 

J On this subject we find Vogel expressing himself, in his section on the various 
forms of hyperemia, in the following satisfactory manner: — 

" In typhus, petechial, and putrid fever, &c, the extravasation of true blood is very 
frequent, but is always dependent on laceration of the vessels ; and in producing this la- 
ceration, a change in the composition of the blood can only act a very secondary part. 
It can only act through a series of means, by favouring congestion and stagnation of 
the blood." And in another place he says: " Extravasated blood always proceeds 
from the vessels, and results from their laceration. The view that, at least some of 
these effusions of blood may occur without any injury of the vessels, by a mere trans- 
udation of the blood through the attenuated vascular walls (diapedesis), is altogether 
untenable, although some even of our recent authors (Carswell among others) still sup- 
port it. The walls of the bloodvessels — even of the smallest capillaries — are so im- 
pervious, that it is impossible for such large particles as the blood-corpuscles to pass 
through them in an uninjured condition." — Path. Anatomy, p. 93. 



18 AN INQUIRY INTO THE 

livid-purple tint, as well as the maculae of typhus, are as plainly the 
result of true stasis"* 

Disturbances oe the Digestive Organs. — Under this head 
could be classed many of the symptoms characterizing typhoid fever. 
In the earlier part of the disease there is often loss of appetite, thirst, 
nausea and vomiting, together with a great variety of other symp- 
toms, indicating a disordered condition of the nutritive apparatus; 
but the symptom which it is our object here more particularly to 
dwell upon, and the one which has been admitted by all to constitute 
an important part of the disease, if not the disease itself, is diar- 
rhoea. 

Louis reports it as present in all but three of his fatal cases ; and 
in relation to the time of its commencement, his statistics show that 
out of forty fatal cases, from which he was able to obtain information 
on this point, twenty-two had somewhat frequent and liquid dejec- 
tions on the first day of the disease. And in all the cases which 
died, lesions of the small intestine were the only constant pathologi- 
cal appearances, and these were always the first, so far as was appre- 
ciable, to commence. In favourable cases, the diarrhoea is sometimes 
absent, or makes its appearance quite late. There also appears to be 
a marked correspondence between the severity of the disease and the 
prominence of diarrhoea in any given case. Thus, in the eighty-eight 
favourable cases given by Louis, fifty-seven were found to experience 
severe symptoms, and thirty-one, slight ones ; out of the fifty-seven 

* Vogel, again, is very plain on the above point, as well as in reference to the source 
from which these vessels derive their energy. His remarks express well what we wotdd 
indicate in relation to' these two states of the capillaries. "In many cases capillary 
hyperemia is undoubtedly dependent on the nervous system; this, from whatever 
cause it is induced, gives rise to dilatation of the capillaries, and relaxation of their 
walls ; the dilated capillaries receive, on purely mechanical grounds, more blood than 
they previously did ; and a capillary which in its normal condition could admit 5 1 f the 
passage of only a single row of corpuscles, may now admit of two or three. A.t the 
same time an excess of plasma escapes through the attenuated walls of the capilla- 
ries. [Hence the papulae of typhoid fever are elevated by this plasma.] The part 
affected contains an excess of blood-corpuscles, and hence appears reddened. This is 
the condition which is known in pathology as congestion — it frequently occurs in the 
living body in external parts, as in the face, the eye, or the skin. * * * As that form 
of capillary hyperosmia in which there is no stagnation of the corpuscles is termed 
congestion, so the higher degree (where they stagnate, and the local circulation is arrested) 
is termed stasis.'" In the same place he also indicates it as his opinion, that this pas- 
sive or hypostatic hyperasmia is the result of nervous depression. Who could ask a 
more exact portraiture than the above, of the cutaneous phenomena in the two types 
of continued fever ? 



NATURE OF TYPHOIDAL FEVERS. 19 

subjects who had more or less severe symptoms, twenty -four had 
diarrhoea from the commencement of the disease, which will be found 
to be a somewhat smaller proportion than obtained in his fatal cases. 
Among the other patients, five had it on the second day, three on 
the third, four on the fourth, &c. &c. ; in two cases, it appeared as 
late as the 18th and 30th days, but these were very mild cases, 
the only symptom of the disease being loss of appetite, weariness, 
loss of strength, &c, which continued for twenty-five days in one of 
the cases; indeed, we can hardly regard these as cases of typhoid 
fever, until after the supervention of the diarrhoea. 

The length of its duration is variously reported by authors ; the 
sum of Louis's severe cases would show an average of about four 
weeks, which, perhaps, would be found in any estimate made from 
so large a number of cases, to be about its ordinary duration. The 
reports of most writers favour the opinion that its duration is equal 
to that of the disease itself, beginning with its access, and generally 
continuing in a more or less degree till after convalescence is fairly 
and fully established. 

The number of the discharges will be found to vary from one or 
two to twenty or thirty a day ; and a cause of great discrepancy in 
reports of the disease in relation to this symptom, has been that 
many authors do not regard liquid but infrequent stools as cases of 
diarrhoea ; while others, among whom is Louis, regard all cases, 
wherein the thin passages are found, as presenting the complication 
of this symptom. We do not think it necessary here to argue which 
mode of estimating is proper, but for our purposes, the plan of deter- 
mining by the quality, rather than by the number of the discharges 
being most available, we have considered all, as cases with diarrhoea, 
whenever the discharges were of a liquid character, independent of 
the action of cathartics. Inasmuch, as our pathology of the disease 
is more plainly indicated by the aberration in the secretion, than by 
any other circumstance in this connection, we have considered this 
pathological condition more or less present, whenever this aberration 
has been found to exist, and in this view, we are corroborated by 
the observations of all our best and most philosophic observers, 
Bretonneau, Chomel, Louis, Bartlett, Jenner, and Flint; and, in- 
deed, every fact in regard to this subject corroborates the opinion, 
that it is the character of the stools rather than their frequency, 
which marks the existence of intestinal lesion in typhoid fever. 

The stools are generally of a liquid character, of a yellowish or 
dark-brown colour, more resembling, according to Dr. Bartlett, new 



20 AN INQUIRY INTO THE 

cider, than anything else. Louis speaks of them as being like coffee- 
grounds ; perhaps the best description we can give, is that they re- 
semble muddy coffee, more nearly than any other liquid. All authors 
seem agreed that they in general contain but little or no mucus, and 
but seldom resemble in character the discharges found in ordinary 
diarrhoea, and that they are seldom complicated with those of a 
dysenteric character. Their odour is fetid, though not invariably 
so. There is frequently more or less blood found mixed with the 
passages. In two cases reported by Louis (Obs. 18 and 44), the 
blood was pure and fresh; in the majority, it presented the appear- 
ance of being coagulated, and gave to the evacuations the appearance 
and consistence of coffee-grounds, which he says is very remarkable, 
inasmuch as evacuations of this nature were seldom if ever ob- 
served in the course of acute diseases, other than the typhoid affec- 
tion, and because, when we may be in doubt as to the nature of any 
disease, their existence will contribute very much to make the diag- 
nosis more clear and satisfactory.* 

Pain in the Abdomen. — In connection with the diarrhoea, abdomi- 
nal pain is found to be a very common attendant on typhoid fever. 
It occurs most frequently in the right iliac fossa, in the hypogastric 
and umbilical regions, and is generally in direct relation in its 
severity to that of the diarrhoea. It is oftener of a dull aching cha- 
racter than otherwise, and sometimes there is only a slight soreness on 
pressure. These pains and their relations to the lesion of the intes- 
tinal canal, have been very fully considered by M. Louis, who thinks 
that they indicate a diseased condition of the mucous membrane of 
the small intestine with scarcely less certainty than does the diar- 
rhoea itself. In a great number of his patients, these pains began 
before the diarrhoea, often on the first day of the access of disease ; 
and though they were generally very shortly succeeded by diarrhoea, 
yet not invariably, nor should we necessarily expect them to be, 
inasmuch as we know full well that in true enteritis, diarrhoea does 
not uniformly occur on the first day, although the seat of the inflam- 
mation is in one or other of the intestines. f Dr. Bartlett describes 
them as continuing frequently through the whole course of the fever, 
and as being often the only cause of distress to the patient. 

Meteorism or tympanites, is an intestinal symptom, to which M. 
Louis and most authors attach the greatest importance. The flatu- 
lent distension of the abdominal parietes was found by him to occur 

* Louis. Part III. page 18. f M. Louis. Part III. Chap. 1. 



NATURE OF TYPHOIDAL FEVERS. 21 

in thirty-four out of forty-six cases of the disease. It was variable 
in its time of coming on ; sometimes within a few days of the attack, 
but generally much later. By a few writers, in which number is Dr. 
Hale,* of Boston, it is reported as occurring most frequently quite 
early, but Dr. Bartlett says this is entirely opposed to his own ob- 
servation and the experience of many of the best authorities. 

" It varies in degree," says Dr. B., "from a slight rigidity of the 
muscles and straightness of the parietes to the extremest distension; 
in such cases occasioning, by its mechanical action on the lungs, no 
inconsiderable degree of dyspnoea. It generally persists after its 
first appearance till the fatal termination, or the approach of con- 
valescence ; although it is not usual for it to vary considerably in 
degree, at different periods of the fever. The flatus rarely passes 
off per anum, and seems to be but little disturbed by the peristaltic 
motion of the intestines. "| 

tin relation to its diagnostic value M. Louis remarks : " In the 
same proportion that meteorism was frequent in individuals attacked 
with typhoid fever, so it was rarely observed in the course of other 
acute diseases. Out of eighty subjects, the greater part of whom 
had diarrhoea, six only had meteorism ; four pneumonic patients out 
of fifty-six had some meteorism during three or four days also ; but 
only two out of forty-six attacked with eruptive diseases, had any me- 
teorism." He did not meet with this symptom in other acute diseases, 
even in any one of the eighty-six cases of enteritis, properly so called, 
whether more or less severe. In speaking of the cause of this com- 
plication, M. Louis says: "Although in the actual state of our 
science, I cannot assign any cause for meteorism, I would, neverthe- 
less remark, that it seemed to me to follow a law which was analogous 
to that by which other symptoms were governed ; since, as in those 
attacked with the typhoid affection, its frequency and force were pro- 
portionate to the degree of severity of the principal disease ; and 
among the others, those alone had it in whom the febrile excitement 
was the most marked; at least such was commonly the case. "J 

Pathological Lesions. — For the description of the anatomical 
lesions of typhoid fever, various plans and classifications have been 
devised; but as, in the present inquiry, it is indifferent as to the result 
what mode we adopt, we have chosen that which seemed most con- 

* Medical Communications, Massachusetts Medical Society, 1839. 
-j- Essay on Fevers, page 76. 
X Louis. Part III. page 36. 



22 AN INQUIRY INTO THE 

venient, and which would place those particular changes from which 
we deduce our views of the pathology of the disease in the most dis- 
tinct relation with the other data under consideration. Many of the 
pathological changes observed in this disease are considered by 
authors as merely of an accidental or occasional nature; while others, 
from their frequency, indeed invariableness, have been regarded as 
the essential lesions of typhoid fever. 

The Brain and its Membranes are seldom the seat of any very 
important lesion in this disease, which fact is very surprising when 
we consider the amount of functional derangement so constantly 
present. When these lesions exist, they are not of a character 
which shows any important relation to the phenomena of the disease, 
nor are they at all proportionate to the severity of the symptoms 
which pertain to disturbed functions in these organs. Chomel ex- 
amined the brain and its membranes carefully in thirty-eight cases ; 
there was no appreciable alteration whatever in fifteen cases. The 
other cases presented nothing very striking ; serous effusions, more 
or less vascular injections in the membranes and brain itself being 
their chief characteristics.* Dr. Flint, of Buffalo, has also made the 
report of a few cases wherein he has made careful examinations of 
these facts, but with results not materially varying from those of 
other authors ; in no case was there any softening of the brain it- 
self, f Louis examined forty-six cases. There was subarachnoid 
effusions in twenty-eight, vascularity and more or less injection in 
the remainder. 

In relation to this class of lesions Dr. Bartlett remarks, " there 
is no ascertained relation between the cerebral symptoms during life 
and the pathological conditions of the brain and its membranes after 
death. Delirium and somnolence are found to have occurred as fre- 
quently, and to have been as strongly marked, in patients whose 
brains presented no changes, or exceedingly slight ones after death, 
as in those of an opposite character. Again, it is obvious that these 
lesions are in no way peculiar to typhoid fever, since they are found 
almost as frequently in patients dead from other acute diseases, ex- 
cluding those of the brain itself and its envelops, as in those dead 
from fever. "J 

The Heart and Circulating Apparatus were found altered in about 
half of Louis's cases, the alteration consisting in the substance of 

* Chomel, Lecons de Clin. Med. p. 294. 

■f First and Second Reports on Continued Fever. 

J Treatise on Fevers, p. 90. 



NATURE OF TYPHOIDAL FEVERS. 23 

the heart being of a pale colour and soft flabby consistence. In 
seventeen of his cases (in number, forty-six) the softening was so 
tv ell marked that the tissue could be readily broken down. This 
softening was generally accompanied with great flaccidity of the 
organ, though they would occasionally exist separately.* These al- 
terations, according to most authors, are accompanied by changes of 
colour, the substance of the heart becoming pale and sometimes of a 
livid or violet tinge. Dr. Jenner's examinations also corroborate 
the above, a good proportion of his cases presenting the same altera- 
tions.'f The condition of the heart does not differ very materially 
in the two types of continued fever, it being found "flabby, soft, easily 
broken down in the typhus as in the typhoid variety." Here, per- 
haps, we can more appropriately than elsewhere notice the condition 
of the voluntary muscles, between which and the condition of the 
heart there is found a remarkable difference. We find no account 
elsewhere than in Louis's researches. He remarks : " I examined the 
muscles which govern the voluntary movements, in nearly all the 
subjects, and I found them nearly always natural with regard to 
colour and consistence ; and this is the more remarkable, inasmuch, 
as I observed before, the heart was more or less seriously softened 
in a great number of cases. (Vol. i. p. 352.) 

Louis describes the internal surface of the aorta as changed in 
colour in more than half of his cases. The alteration consisted in 
patches of morbid redness, sometimes very bright, and extending 
from the ascending aorta to its bifurcation, and even sometimes be- 
yond it. The discoloration extended generally deeper than the 
lining membrane of the vessel, and was proportionate in its intensity 
of colour, and also in the amount to which the coats were involved, 
to the degree of flaccidity and softening of the heart. 

Louis remarks in relation to this feature ; that " the colour of the 
aorta has been particularly investigated of late by many distin- 
guished physicians. Some have considered the red colour as simply 
the effect of imbibition, met with in violent deaths as well as in vari- 
ous diseases ; others have regarded it as the result of inflammation 
on which depended a series of symptoms called inflammatory fever. 
But the facts we have just analyzed cannot, it seems to me, be 
accounted for under either of these hypotheses." He then asks: 
If it be simple imbibition, why is the aorta not discoloured in all 

* Louis's Researches on Typhoid Fever, vol. i. p, 331. 
f Typhoid and Typhus Fever, p. 80. 



24 AN INQUIRY INTO THE 

cases where blood is found in its cavity ? On the other hand, if it 
is inflammation, why did not these patients present symptoms differ- 
ent from those the aorta of which did not present these discolora- 
tions ? He finally seems inclined to the opinion that it depends 
npon the imbibition of the blood, but that the special alteration 
which it has undergone in this disease is a necessary prerequisite 
to the imbibition. f The most rational explanation of the above 
appearance, to our mind, is that it is dependent upon the same 
condition of the small vessels supplying the walls of the aorta, the 
vasa vasorum, which operates in the minute cutaneous capillaries 
in the production of the spots and congestion on the cutaneous sur- 
face ; for we know there are many diseases in which similar altera- 
tions of the blood occur as in typhus, and yet no such discoloration 
is observed in the aorta.f 

The Lungs have been found very frequently presenting marked 
and peculiar alterations. Louis found them nearly natural in fifteen 
out of forty-six of his cases, which he says is the proportion in 
which he found them affected in other diseases, excluding of course 
those of the lungs themselves. Chomel reports ten in forty-two 
cases. Dr. Jenner says that " congestion is very frequent in those 
dead from typhoid fever, and rare in those from typhus fever." He 
calls it the lobular non-granular consolidation of the lungs, which he 
thus describes : "Externally, a portion of lung in this condition has a 
mottled aspect ; here and there patches, varying in size from a single 
lobule, to half or more of a lobe, of a deep bluish, chocolate, violet, 
or purplish slate colour, bounded by a well-defined angular margin, 
crossed, if it includes more than one or two lobules, and mapped out 
into smaller patches by dull opaque whitish lines. * * * Scattered 
in the midst of the larger patches are frequently found one or more 
healthy lobules." Dr. Flint describes this condition of the lungs 
as a sort of pseudo-pneumonitis, which probably results from the 
passive engorgement of the lungs, and seems to think it more fre- 
quent in typhus than in typhoid fever. 

Dr. Bartlett says also, " that it is quite unlike, in almost every 

* Louis's Researches on Typhoid Fever, 291. 

f Andral and Gavarret have made four analyses of the blood of three persons suf- 
fering from scarlatina, which indicate decidedly the existence of hypinosis. Lecanu 
has also made two analyses of the blood in this disease, and has obtained nearly simi- 
lar results. — Simon, Chemistry of Man, p. 246. Hassall also places smallpox, scar- 
latina, and measles in the same category, and describes the character of the blood as 
nearly identical in all, in this respect. — Microscopic Anatomy, vol. i. p. 147. 



NATURE OF TYPHOIDAL FEVERS. 25 

respect, the secondary stage of inflammation, although the term 
hepatization has sometimes been applied to it. It is not indicated 
by any peculiar symptom during life, and he farther expresses the 
opinion that neither the symptoms nor the lesions go to show that 
the lungs play any very important part in the numerous and com- 
plicated phenomena of typhoid fever;"* but from the comparative 
uniformity of their occurrence we are disposed to form a somewhat 
different opinion, and to think their frequency and character are such 
as to allow the deduction that the lungs, like many other viscera, are 
immediately under the reign of those morbid influences or conditions 
upon which the disease depends. 

The state of the blood is very properly accounted as being among 
the anatomical changes, though examinations of this fluid are gene- 
rally made previous to -the death of the patient. From the numer- 
ous examinations of Andral and Gavarret, besides many others, the 
blood appears to exhibit the characters of hypinosis ; one of the cha- 
racteristics of which state is diminished fibrin ; more frequently in 
typhoid and typhus fever than in almost any other disease. The 
blood in this disease, says Simon, is very deficient in fibrin, and fre- 
quently also in albumen. It coagulates imperfectly and often re- 
mains in a semifluid state, and when a clot is formed, it is soft and 
scarcely ever covered with a buffy coat. The character of the blood 
appears to be very much the same in the typhus as in the typhoid 
type of continued fever, as likewise are the pathological lesions re- 
ferring to the heart. Blood more generally dark in the former. 
The state of the blood in the typhoid affection, however, is not uni- 
form, for, as Simon remarks, it varies much at different times, which 
has been the cause of much discrepancy in the accounts of various 
authors ; thus, in the stage of excitement, instead of having too little 
fibrin, it is often found to contain more than in the normal state, 
becoming then in the opposite condition of hyperinosis. From this 
it would appear that the state of the blood in the typhoid affection 
cannot be of the paramount significance that many authors would 
claim for it ; for during the times that this fluid is presenting these 
very opposite chemical and physical attributes, the main character- 
istic phenomena of the disease do not appear to be at all altered in 
correspondence with them, and therefore must depend upon some 
other influence than the state of the blood for their continuance, 
otherwise they would be subject to interruptions. If they depend 

* Treatise on Fevers, p. 87. 



26 AN INQUIRY INTO THE 

upon hypinosis, reason would not tolerate the supposition that they 
remain unaffected during hypinosis. 

Abdominal Viscera. — The changes which occur in these organs 
are by far the most important incident to the disease, and hence we 
have as one of its synonymes typhus abdominalis; indeed, if we except 
the weak and accelerated pulse and the altered condition of the 
heart and blood, nearly all the phenomena, both symptomatic and 
post mortem, may be said to refer to the abdominal viscera. 

The spleen, with only four exceptions, was more or less seriously 
changed in all of Louis's cases. Its structure was ordinarily soft- 
ened, sometimes thickened, and frequently four or five times larger 
than natural. Dr. Jenner says, " that it was enlarged in all his 
cases of typhoid fever ; softened in one-third of the cases only." 
Dr. Bartlett reports it as more frequently enlarged in typhoid than 
in typhus fever. 

The liver was softened in half of Louis's cases, in some to a re- 
markable degree. Dr. Jenner says that this again, together with 
the pancreas and kidneys, were more flabby in the cases of typhoid 
than of typhus fever. There was an ulceration in the lining membrane 
of the gall-bladder in one of fourteen cases of typhoid, and in nine 
of thirty-one cases of typhus ; in the latter disease, the bile was 
much more thick and of a darker green colour than in the former 
disease. Dr. Bartlett adds, that this difference in the appearance of 
the bile in a large majority of cases is well marked in the two dis- 
eases. 

The urinary bladder was found ulcerated in one of Louis's cases, 
and also in one of Dr. Jenner's cases of typhoid, but in no one of 
typhus fever. 

Under the head of Organs of Respiration,* Louis describes vari- 
ous changes in the epiglottis, glottis, larynx, and trachea; such 
as ulceration, red patches, &c. &c, and remarks, that with the ex- 
ception of that of the trachea, all the mucous membranes were more 
or less thickened, reddened, softened, and a certain number of times 
ulcerated, in patients who died of typhoid fever. 

The pharynx and oesophagus, in a large proportion of Louis's 
cases were found in a healthy condition, but there occurred with con- 
siderable frequency ulcerations of the mucous membranes of these 
parts ; in the case of the pharynx, in a proportion of rather more 
than one-sixth of the cases. These ulcerations varied from one to 

* Louis, Researches on Typhoid Fever, vol. i. p. 294. 



NATURE OF TYPHOIDAL FEVERS. 27 

six or eight lines in diameter and were various in their contour ; 
generally superficial. In relation to these changes, Louis remarks: 
" Ulcerations of the pharynx and oesophagus having occurred only 
in a small number of typhoid patients, and in no other disease, may 
be considered among the anatomical characteristics of the former ; 
though they are secondary, these are very important characteristics, 
nevertheless, because it would be only necessary to find ulcerations 
in the pharynx or oesophagus in a patient who died of an acute dis- 
ease in order to be almost sure of the nature of that disease."* 

Dr. Jenner found inflammation with or without ulceration of the 
larynx and pharynx present in about half his cases. His analysis 
leads him to the conclusion that the laryngeal inflammation is se- 
condary to the pharyngeal, and that laryngitis, independent of pha- 
ryngitis is extremely unfrequent in typhoid fever. f 

Lesions of the Alimentary Canal. — Of all the anatomical 
changes pertaining to typhoid fever, there are none so peculiar and 
characteristic of the disease, none which are so plainly and unmis- 
takably indicated by the symptoms during life as those which refer 
to the alimentary canal. So constantly do these lesions attend the 
peculiar phenomena which characterize typhoid fever, that at the 
present day, the one and the other set of facts are considered as 
invariably constituting essential parts of the disease, and in many in- 
stances these are the only characteristics which determine the posi- 
tive existence of typhoid fever ; so that these changes have become 
the terms by which the disease itself is indicated, as dothinenteritis, 
follicular enteritis, &c. 

The stomach was found to present post-mortem changes in about 
two-thirds of Louis's cases. The alterations of which it was the seat 
consisted in changes of colour, consistence, and thickness. It was 
sometimes mamellonated, and four of his cases presented ulcerations ; 
these ulcerations were small in size, superficial, and not very nume- 
rous. Chomel found various changes in the mucous membrane of 
the stomach, but was not able to discover ulcerations. Dr. Flint 
describes a remarkable and to us an important post-mortem fact as 
occurring in several of his cases, which we have not been able to 
observe in the reports of others. It is the presence of ecchymoses, 
of more or less extent, in the mucous membrane of the stomach. He 

* Researches on Typhoid Fever, vol. i. p. 383. 
f Bartlett's Treatise on Fever, p. 91. 



28 AN INQUIRY INTO THE 

speaks of them as presenting "punctated redness, or ecchymoses," 
and expressly states that there was "no eapilliform redness" in the 
cases where this appearance was observed. " The mucous mem- 
brane," he says, "was softened; several ulcerations, varying in 
size and form, the largest half an inch in length and three or four 
lines in width, superficial, apparently having penetrated only the 
mucous coat These appearances were limited to the larger curva- 
ture. The organ at this part was easily torn, a rent occurring in 
removing it from its spinal attachments." In another case he again 
remarks, "the stomach, on its internal surface, presented several 
patches of ecchymoses."* 

Louis, who has paid great attention to the gastric pathological ap- 
pearances, was not able to make out any very important relationship 
between them and the gastric symptoms previous to the death of pa- 
tients in whom they existed. He observed that in many cases the 
lesions existed after death, where there had existed no gastric indi- 
cations of their presence during life, and that distress in the epigas- 
trium, with nausea and vomiting, often existed when the mucous 
membrane was found healthy. Chomel was alike unsuccessful in 
establishing any constant relationship between these two sets of 
phenomena. Flint makes a similar remark with regard to a few 
cases in which he made post-mortem examinations ; thus, " in two 
fatal cases in which the stomach exhibited lesions, ulcerations in one 
of them, vomiting is not noted to have occurred. "f 

From this feature of non-correspondence between the symptoms 
of irritation in the stomach and the amount of gastric congestion 
and ulceration, together with the peculiar character of the con- 
gestions, as just noted from Dr. Flint, being of a hemorrhagic or 
ecchymosed character, we would reasonably infer that they are 
passive in their nature, and seldom dependent on nervous irritation 
of the stomach, but are the result of passive engorgement of the 
vessels ; and, indeed, when closely considered, all the mucous con- 
gestions pertaining to typhoid fever, will be discovered to be mark- 
edly of this passive character, and but little or not at all productive 
of irritation. There is deficiency rather than excess of action in the 
vessels, and the nervous susceptibilities of the mucous surfaces ap- 
pear to be unaccountably obtunded, to what would rationally be ex- 
pected to act as causes of great irritation, such as ulcerations, thick- 

* First Report on Continued Fever, pp. 128-129. 
f First Clinical Report, p. 79. 



NATURE OF TYPHOIDAL FEVERS. 29 

enings, &c. ; as we have just seen that ulcerations exist in the 
stomach without vomiting, and in many cases of congestion else- 
where, as in those of the conjunctiva, when it did not increase the 
susceptibility of the eye to light.* And again, in the cases of 
diarrhoea, the urgency of the evacuations was not very pressing, in- 
asmuch as it was often necessary to call the attention of patients to 
the subject, by asking them if they did not desire to evacuate the 
bowels. f We never observe in the diarrhoea of typhoid fever any- 
thing like the tenesmus, so common in other forms of enteric dis- 
order; and yet the amount of actual disease in the intestine is far 
greater than in many of them. 

The Small Intestine. — The characteristic lesion of typhoid 
fever, and, of course, by far the most interesting of all the anatomic 
changes observed in this disease, is found in the small intestine ; its 
existence is invariable, and in many instances it is the only distin- 
guishing trait of the disease. It consists of changes, varying in char- 
acter, in the mucous follicles, known as the glands of Peyer, found 
along the mesenteric portion of the canal. The character of these 
alterations has been found to vary very much, in proportion to the 
duration of the disease and their distance from the ileo coecal valve, 
where the follicles are uniformly the subject of more serious altera- 
tions than elsewhere. Louis found the elliptical patches of the ileum 
more or less seriously changed in structure in all the patients the 
report of whose cases he subjected to analysis. The region in which 
they were infected, varied from the last two to eight feet of the 
canal. They were affected throughout the whole length of the canal 
in one case only. His description of these changes is more extensive 
and minute than we consider necessary for the purposes of our analy- 
sis, but we will give the substance of them in this place. 

He found that the changes, from a healthy condition of the patches 
to an alteration of structure, took place sometimes, in a gradual man- 
ner; but generally it was the reverse, and with all, or nearly all, the 
different degrees of the lesion were found in the same patient. In pass- 
ing from the patches which were least altered to those which were most 
so, he found that they presented the following appearances : the first 
were very slightly elevated and pale, or of a faint rose colour ; the 
orifices of the crypts were obliterated, and there was slight softening 
of the mucous membrane ; next, came patches in which the thicken- 

* Flint's First Report, p. 53. f Ibid. p. 83. 



30 AN INQUIRY INTO THE 

ing, softness, and redness were more marked. " The first of them had 
in some cases a surface which was granulated, upon which was seen 
a greater or smaller number of the open orifices of the crypts. In 
this state of alteration the most remarkable effects of the lesion was 
the development, and, if we may so express it, the exaggeration of the 
natural structure of the parts." The patches were raised, and also 
the mucous membrane which aided in its formation. . The submucous 
cellular tissue was more or less affected, and of a pale rose colour.* 
These conditions became more and more marked and exaggerated — 
that is, the patches became thicker, redder, and softer, till various 
stages of ulceration are detected ; some superficial, and just com- 
mencing, with an imperfect destruction of the mucous membrane ; 
others deeper, with its entire destruction. Sometimes they are dis- 
tinct, at others they run into each other, so that the entire destruc- 
tion of the mucous membrane over the whole extent of a patch is 
thus produced. The submucous and muscular coats also participated 
in these alterations, and the peritoneum became ruptured. Some- 
times these alterations took place very rapidly, and perforation of 
the intestine would result at an early stage of the disease. 

In many of the cases which died late in the disease, he found evi- 
dences of a reparative process having been set up in these ulcerated 
patches, and this was always more marked in that region of the in- 
testine in which these ulcerations had begun, viz., the vicinity of the 
coecum. In addition to the above, Louis also describes other 
changes that relate to the elliptical plates, which, he says, are 
peculiar to the submucous tissue. " Instead of being simply some- 
what reddened and moist, without other change of structure — instead 
of partaking in some measure of the inflammation of the mucous 
membrane which covered it, as in the preceding variety, the cellular 
tissue was transformed, either through the whole extent, or nearly 
the whole extent of the patches, into a homogeneous substance, 
without apparent organization, of a pale rose or yellow colour. It 
was from two to three lines thick. 

" It was easy to see that this substance was not secreted from the 
surface of the submucous tissue, but into its substance, on making 
an incision through it. These deposits were covered by mucous 
membrane, more or less reddened in proportion to its advance to- 
wards ulceration, which was the ultimate tendency of the parts in 
which they occurred." Louis says these deposits occurred in some- 

* Louis's Researches on Typhoid Fever, vol. i. p. 174. 



NATURE OF TYPHOIDAL FEVERS. 31 

what less than one-third of his cases. In relation to the character 
of the deposit, M. Vogel remarks : " This must in every case be 
deposited in a fluid state, and subsequently assume the solid form 
by coagulation ; otherwise, it would not so completely fill up all the 
interstices between the tissues. Upon examination, however, it is 
always found coagulated ; at least, I am unacquainted with an in- 
stance where it was observed still fluid." Again, he says : " The 
question of the origin and signification of this typhus matter can 
only be partially answered by pathological anatomy." It appears 
to be ascertained that this matter is secreted in a fluid state from, 
the capillary vessels. Moreover, the cause of this separation is 
doubtless a local hyperemia of the vessels ; which, indeed, may be 
readily proved by direct observation. The secreted matter is there- 
fore a part of the blood, which, shortly after its separation, coagu- 
lates. But we are acquainted with no principle of the human body 
which is capable of spontaneous coagulation, but fibrin. Of this, 
therefore, the typhous matter must principally consist — it is, as in 
similar cases, pervaded by the other elements of the blood. 

" The question here suggests itself — Is this fibrin normal, or has it 
undergone a specific change ? The possibility of such a change can- 
not be denied, since we know that fibrin is very transmutable; but 
the assumption of such a change, without a demonstration of its na- 
ture by organic chemistry, is of no advantage in a scientific point of 
view. By such a hypothetical transmutation of the fibrin, we may 
endeavour to explain — Why the typhous deposit is not converted into 
normal pus, but breaks up loithout any distinct organization. 

" To this view may be opposed another, equally plausible. It is 
very probable that, in typhus, the normal properties of the tissues 
are deprived of their ordinary energy, and that the formative power 
is impaired. In this diminished energy of the original tissues may 
likeivise be sought the reason why the exudation does not become or- 
ganized, but undergoes disintegration. With this brief view of the 
subject, I wish to express myself as opposed to the opinion that there 
exists in the blood a specific typhous matter, with the deposition of 
which (in certain parts of the body) the disease localizes itself, and 
terminates." 

From the above, it would be plainly inferred that the deposit de- 
pends upon a congestion or hyperemia of the capillaries of the 
mucous and .submucous tissues differing in character from inflamma- 
tion — rather a condition of stasis similar to what has been observed 



32 AN INQUIRY INTO THE 

in the capillaries of the cutaneous surface in the typhus type of 
continued fever. 

Another variety of disease in these follicles is mentioned by For- 
get under the name of gangrenous. The substance of the gland 
loses its vitality and becomes of a yellowish or greenish colour ; its 
edges, growing ragged and shreddy, are detached, and finally the en- 
tire gland is thrown off. Dr. Jenner says that "when the whole 
of the deposit has sloughed out no fresh deposit is formed, and con- 
sequently, as the whole of that deposit is seated in the submucous 
tissue, destruction of the muscular fibres of the intestine must be 
the result of simple ulceration." 

In addition to the above alterations in the small intestine, which 
refer exclusively to the glands of Peyer and Brunner, there are 
other conditions of this viscus which we consider no less important 
in an impartial analysis of the phenomena of typhoid fever. We 
refer to the congestions of the general mucous surface independent 
of the elliptical patches. It has been so uniformly the habit of pa- 
thologists since the time of Louis and Chomel, to regard every other 
abnormal appearance in the mucous surface of the small intestine 
as entirely of a secondary nature, that though we find, it is true, a 
sufficiently accurate description of these changes, yet certainly no 
stress is laid upon them, nor are they generally allowed to have any 
important significance in the pathological relations of the disease. 
It is not our object to give any very extended and minute descrip- 
tion of them, but having formed views somewhat peculiar in regard 
to the ultimate pathology of this disease, and regarding this condi- 
tion of the mucous surface as affording a corroboration of those views, 
nearly as strong as that afforded by the follicular changes them- 
selves, we would, on no account, pass them over without decided 
reference. Thus, we find the mucous membrane, independent of the 
elliptical plates and isolated follicles, to be, in a majority of cases, 
preternaturally red. This redness is sometimes continuous, at other 
times it is in zones or patches. It sometimes extends over a large 
portion of its tract. In some cases, where there has been hemor- 
rhage from the bowels, blood is found in the intestine, and in addition 
to this, the mucous membrane is the subject of sanguineous infiltra- 
tion, and this condition of the membrane is observed where there has 
been no hemorrhage. It may exist to the extent only of a few 
inches, or of several feet. It is generally continuous, not in patches 
or zones. The colour of the membrane ranges from a rose to a very 
dark red, and it has a peculiarly brilliant and trembling or quivering 



NATURE OF TYPHOIDAL FEVERS. 33 

appearance, like jelly. Chomel found this lesion in seven out of 
forty-two cases. He is very confident that it is intimately connected 
■with the hemorrhage from that portion of the membrane which it oc- 
cupies.* 

The point in reference to this condition of the mucous membrane to 
which we would call attention, is this : that it indicates most positively 
an enfeebled condition of the bloodvessels, resulting in that complete 
stagnation of the blood which is denominated stasis, and the analogue 
of which we described somewhat at length, as occurring in the cuta- 
neous congestions of the typhus type of continued fever. And not 
only do we claim this appearance after death as corroborative of this 
view, but in as strong a degree do we attribute the hemorrhages to 
the same condition of the vessels. 

There is one more point in relation to the small intestine and we have 
done, and that is the almost entire exemption of the duodenum from 
ulcerations and the peculiar lesions of typhoid fever. Louis's reports 
show that this portion of the small intestine was healthy in nearly 
all his cases, with the exception of being somewhat reddened and 
sometimes softened, but rarely ulcerated. 

The Large Ixtestixe was found the subject of pathological 
changes in a good number of cases. Besides the condition of me- 
teorism, which was very common, its mucous surface was found red- 
dened with more or less deep shades ; also thickened and softened 
conditions were not uncommonly met with. Louis says : " The parietes 
of the large intestine became thicker than usual, sometimes resem- 
bling the condition in which we find the coats of the small intestine in 
strangulation. ... Its mucous membrane was white in thirteen of 
his cases, and red, over a certain extent, in twenty, grayish in nine; 
it was of its usual consistence in one-fourth of the cases ; it was 
softened, in various degrees, over a greater or less extent of surface, 
and was sometimes thickened in the others. Eight presented a cer- 
tain number of lenticular crypts, few of which were ulcerated ; four 
had hard, some rounded patches similar to those of the ileum ; four- 
teen had ulcerations, which were generally few in number, superficial, 
and of small size."f 

Dr. Bartlett speaks of the mucous membrane as presenting ulcera- 
tions in about one third of the cases, and that they were present in 

* Bartlett. Treatise on Fevers, p. 93. 

f Researches on Typhoid Fever, vol. i. p. 376. 



34 "AN INQUIRY INTO THE 

twenty-three of seventy-four examinations made by Louis and Earth. 
He says that they occupied most frequently the ccecum, though they 
were not confined to that portion of the intestine. In a small num- 
ber of instances the submucous cellular substance of the isolated 
follicles were found to have undergone the same yellowish transform- 
ation that has already been spoken of as occurring in the elliptical 
plates of the small intestine.* 

Although the large intestine has been found less frequently the 
subject of disease than the small intestine, still its post-mortem 
phenomena are, in our opinion, of too frequent occurrence and of 
too decided a character, to be regarded as altogether secondary, 
and in our analysis it will be our object to show that these, like 
many other of the pathological conditions presented by the various 
organs, are not more 'of a secondary nature than are the changes of 
the elliptical plates of the ileum themselves, and, like these changes, 
are the direct result of causes common to both. Which causes, in 
our opinion, are identical with the ultimate pathological condition 
upon which all the phenomena, both symptomatic and anatomical, 
depend. To the investigation of their nature and influence we will 
presently turn our attention. 

The lymphatic ganglia of the mesentery are very generally found 
in a diseased condition, and the amount of disease which they evince 
seems to correspond with the condition of the elliptical plates of the 
ileum, though this is not invariable, for those found between the 
two layers of the mesocolon are often found in the same diseased 
condition. The changes consist generally in enlargement, softening, 
and alteration of colour — red, bluish or gray — and in the deposition 
of purulent matter in their interior, marked by small yellow points. 

In the course of the foregoing summary we have very constantly 
kept in view the differences between the two types of continued fever, 
although not with that order and regularity which would be neces- 
sary in a systematic treatise on the two diseases. It was only im- 
portant to notice these differences, as they were suggested by the 
description of the symptoms of the typhoid type. Farther, it will 
have been observed that in our description of the symptoms occurring 
under the head of disturbances of the digestive organs, as well as in 
the account of their pathological lesions, we have instituted no com- ' 
parison between the two types. The reason of this omission has 
been, that in the typhus type, none of the symptoms during life, or 

* Treatise on Fevers, p. 100. 



NATURE OF TYPHOIDAL FEVERS. 35 

the post-mortem appearances, pertaining to these organs, seemed to 
have any important connection with the characteristic phenomena 
of the disease, there being neither diarrhoea nor important intestinal 
lesion reported with any degree of uniformity in the typhus type ;* 
and, moreover, of late years the basis of distinction between the two 
types has been the existence or non-existence of disease in the intes- 
tinal canal ; as will be observed in the admirable Treatise of Pro- 
fessor William Jenner, of London, on the Identity or Non-identity of 
Typhoid and Typhus Fevers. 

The object of the present treatise being to arrive at what we con- 
sider the true, or, at least, the most rational theory of the typhoid 
affection, by an analysis of some of the most prominent phenomena 
in its natural history, an extended review of the many doctrines now 
in existence in relation to its pathology, would be inappropriate. 
Suggestions regarding the proximate cause of typhoid fever, will, we 
fear, meet no great degree of favour, for there is no disease in rela- 
tion to which so many theories have been promulgated. The pecu- 
liar condition of the blood, the cerebro-spinal system, and the various 
abdominal viscera, have been each referred to as the pathological 
domain of this mysterious disease ; yet neither, it appears to us, is 
alone adequate to the entire explanation of all its phenomena. 

If we refer it to the state of the blood, and argue on the one hand 
that the continuously rapid and feeble pulse, the pale and softened 
condition of the heart's substance, the slight cutaneous eruption, the 
obstinate passive diarrhoea, the pain and tympanites, the congestion, 
stasis, and hemorrhages in the intestinal mucous membrane, as well as 
the changes and ulcerations in the elliptical plates, found in typhoid 
fever ; and, on the other hand, that the still more rapid pulse, more 
softened condition of the heart's substance, together with the stasis 
and hemorrhagic spots (petechia), found on the cutaneous surface, 
are all the common result of these changes in the blood, and of 
these changes alone; and if we farther admit, with Andral and 
Gavarret, that these changes consist mainly in hypinosis, we must 
at the same time, admit that the theory is embarrassed by a great 
fallacy, viz. that the blood is often in the very opposite state, 
hyperinosis, for a considerable time during the course of the attack, 

* Spontaneous diarrhoea is as rare a symptom in typhus as it is a common one in 
typhoid fever. — Bartlett, p. 216. Amongst Dr. Gerhard's, cases: "In the entire num- 
ber of autopsies there "was but a single case, and that of doubtful diagnosis, in which 
the slightest deviation existed from the natural appearance of the glands of Peyer." 
—Ibid. p. 233. 



36 AN INQUIRY INTO THE 

and yet no corresponding change in the symptoms is manifested. 
And farther, could we reconcile this, we would still find it difficult, 
without admitting the influence of other causes, to account for the 
production of such very dissimilar results in the two types ; the prin- 
cipal manifestation of disease being in a mucous membrane in typhoid 
fever, and in the skin in typhus fever. 

In relation to the cerebro-spinal system, for reasons sufficiently 
obvious, we would find it impossible to explain all the phenomena of 
the disease by here locating its proximate cause ; for neither is the 
character of these phenomena taken as a whole, such as would be re- 
cognized as resulting from disease in the cerebro-spinal axis, nor is the 
correspondence between the severity of those symptoms which are 
plainly referable to this system, and the gravity of the more charac- 
teristic symptoms of the disease sufficiently close to authorize such a 
conclusion. 

A very natural, and on a cursory view, almost inevitable theory, 
in regard to the pathology of typhoid fever, is that it must be either 
solely dependent upon, or very closely connected with, that in- 
variable, and generally very serious amount of disease in the lower 
portion of the small intestine. This lesion, it cannot be denied, pre- 
sents a greater amount of correspondence between its actual extent 
and the severity of the general essential symptoms of the disease, 
than any other set of phenomena connected with it. Louis, if he 
does not entertain this theory of the pathology of typhoid fever him- 
self, has certainly, in his admirable statistical researches, afforded 
the strongest corroboration to others for their belief, and is often 
found expressing himself in a manner very favourable to this doc- 
trine. "Notwithstanding," says he, "the small number of com- 
plications, and the comparative importance of each one of them, the 
symptoms were the same as in a great number of cases, in which the 
secondary lesions were much more grave ; and this with other nearly 
similar facts, shows that almost all the symptoms observed in typhus 
fever, and especially those ivhicli may be called characteristic, depend 
on the peculiar morbid changes in the ileum"* And again : " We 
must conclude that the time, at which the alteration of the elliptical 
patches of the ileum commenced, was the same as that of the disease ; 
and we must not consider this lesion as one of the effects of the fever, 
but that it forms the anatomical characteristic of it."f 

* Researches on Typhoid Fever, vol. i. p. 82. 

f Ibid. vol. i. p. 92. It is with great reluctance that we attempt an interpretation 
of Louis's doctrine as favouring the opinion, that the above changes are the proxi- 



XATURE OF TYPHOIDAL FEVERS. 37 

From the above it would appear, at the very least, that Louis re- 
garded this lesion as one of the greatest etiological importance. But' 
when we give all the facts in connection with the abdominal lesions 
a more careful consideration, we must find that it is impossible to 
account for all the "characteristic symptoms" of the disease, by 
locating its ultimate pathology in this region, for although there is 
a more regular correspondence between the lesions and the symptoms, 
here than elsewhere, still, to attribute the symptoms entirely to this 
local lesion, appears unreasonable, when we reflect that in typhus 
fever, a disease at least similar and even by many considered iden- 
tical, there is, as the rule, no trace of such a lesion, no trace of the 
diarrhoea, or of the pain and the meteorism resulting therefrom. 
Under this view, one of two positions must be assumed, either that 
those symptoms, which the two types possess in common, and which 
endow them with the typhoidal aspect, are due to conditions of the 
organism which have no analogy in the two diseases, and that typhoid 
and typhus fever are two distinct diseases. For if the characteristic 
symptoms arise solely from the intestinal alterations in typhoid 
fever, as these alterations do not exist in typhus, those symptoms 
must have their cause elsewhere. Now it would be very surprising if 
two sets of symptoms, so exactly simulating each other, that the 
most skilful and experienced have denied the least difference between 
them, should arise from entirely different Causes, the one depending 
upon intestinal follicular disease, the other upon some as yet un- 
known cause. Certainly, such a conclusion would not be very philo- 
sophical. This theory, then, like the others, requires to be presented 
in no other light than the above, to show its inadequacy to the ex- 
planation of the phenomena of the typhoid form of fever. 

It may be asked, what theory then can be advanced, to which so 
many rational objections will not be urged ? We candidly answer 
none ; but in our opinion, in the adoption of a theory of this disease, 
we should consider that most stable and philosophic, which, while it 
is as competent as any of the foregoing to the explanation of all 
the phenomena of the typhoid type of fever, yet, presents nothing 
which would exclude altogether from the same order of diseases, its 

mate cause of typhoid fever ; the more especially, as Dr. Bartlett, than -whom no one 
in this country, in our opinion, is better qualified to do full justice to this great patho- 
logist, has expressed his unbelief that such was his opinion. We may be mistaken in 
our interpretation of his expressions, and, therefore, have not charged the doctrine 
upon him, and have only remarked that he appears to have favoured it very decidedly 
in the above-named places. 



38. . *; AN ; INQUIRY INTO THE 

unmistaka4l^-cJpUnterpart-^-its archetype, typhus fever. For, it is 
..->" ^ndeniaKg^t&t these two diseases are inseparably bound together, 
.. '. -in tre 1 i W j'he strongest and most indissoluble, though mysterious, 
** : * affinit^raifd the. necessity,; which any theory may involve, of sepa- 
.;' •. g^lng-.them, is enough/'of- itself, to declare its absurdity. 
- ;y.^Ci# view Which we nave taken in relation to the proximate cause 
-'- ' .'-V^f- typhoid fever, _ is ? we".-, are fully aware, liable to many objections, 
;^-- ":tut after a careful'edhsxdera.tion of it, in all its bearings and depend- 
v;^- .^ncies, we • can^b.ut-regard it as perhaps less obnoxious to fallacy 
" ; 'v- .than most of- ."its : Vcantemp.0raries. " Pathology," remark Todd and 
^So^mai^^^^^ie^^Sj^^gy of disease; anjd it is obvious that no 
" . , -patkoloj^aM confidence, which are not founded 

■ '■;.'. upon §G^urate;:y^ws"b¥' the natural functions," it is equally neces- 
sary, we wOuld^add, ; that :these views be comprehensive as well as 
accurate,' for. without' due importance being accorded to relative phy- 
siology, we mean .that important bearing and relation which the func- 
tions, of .one .portion of the organism has to those of another in health, 
-anymore 'esp'ecially-rn -a'state of disease, we are apt to lose sight 
. t>f^ll3^^^onmg'cand legitimate induction, and to pursue but the 
;- ^waifs' and'shadowspf Vmost uncertain and devious philosophy. 
\ t . •. .' We have seen by only a cursory view, that neither the humoral 
'-. ■"' or -sanguineous theory,' nor the intestinal, nor yet, again, the cere- 
•t>ro-spinai or .nervous- theory of typhoid fever, will account satis- 
■ :factoxily for all its phenomena; we must, therefore, look elsewhere 

• -...for an explanation of them. After the most careful and laborious 
..'". ' ^consideration.. of . tTi'e phenomena, relationships, and events of this 
. ■'•: 'trialy m-y^teiriDus. -di'seafeej- keeping in view, at the same time, as well 

• as We Were able^hel^i^ physiological dependencies of such an 
intricate question^. 'we*'&Se indticed to regard the typhoidal state, 

• manifested" both*, in typjjpfd and typhus fevers, as a morbid affection 
of the whole or '.portions^ the ganglionic system of nerves, known 
.;", . also as th'e^gre^t sj.^f^$&iie nerve, but of the exact nature of which, 
and how produced, we know not. In the succeeding analysis, it will 
be our object to show that the characteristic typhoid phenomena are 
found to occur in a more marked degree, in those portions of the 
organism which are admitted to be, and in most cases can be demon- 
strated as being under the control of the sympathetic ganglia and 
their various nerves, and that the occurrence of other phenomena is 

* Physiological Anatomy, p. 28, London edition. "It is also certain that improve- 
ments in pathology must follow in the wake of advancing physiology." — Ibid. 



NATURE OF TYPHOIDAL FEVERS. 39 

the result of relations, more or less direct, with this important system 
of nerves. In the course of our examination, we shall endeavour to 
show that both anatomy and the most approved physiological doc- 
trine of the present day, are, in a great measure, confirmatory of our 
position, and farther that it will be corroborated by the recorded 
experiments of this and the past century. 

We are aware that referring the pathology of disease to the sym- 
pathetic system of nerves, though not without precedents of the 
most respectable and even revered character,* -is still at the present 
day somewhat unusual, and while, in the confidence of an honest, 
and if not enlightened, we can at least say, a studied, conviction, 
we argue the justness of this pathology, we would ask in the first 
place, that indulgence which the defects of our performance must 
necessf/rily need, and in the second, a full acquittal from the arro- 
gance which we are aware is more than apt to be imputed to him, 
who would deny established, and substitute new doctrines in patho- 

In view of the neglect, of which, at least in this country, the nerv- 
ous system, and especially this portion of it, is the subject, we would 
be unwilling to enter into our analysis without referring briefly, by 
way of refreshing the memory, to some of the most important fea- 
tures in the anatomy and physiology of the ganglionic system of 
nerves. In so doing, we will not embarrass our description with a 
discussion of the many theories in regard to its functions, but will 
give that which we have adopted ourselves as most rational, and 
which, fortunately for us, we are able to say is that most universally 
admitted by the best physiologists of the present day, and which 
vivisection, that best of all tests, has most plainly, and, to our mind, 
incontestably demonstrated. 

The Sympathetic Nerve. Its Anatomy. — In this description, we 
shall give the views of the various authors within our reach who co- 
incide with us in relation to the function of this nerve, using very 
much the same order of description, and also, when its terseness and 
comprehensiveness will admit, their language. 

Under the title of the sympathetic nerve, say Todd and Bowman, f is 
comprehended a great subdivision of the nervous system, which pre- 
sents certain peculiarities of structure and of distribution, whereby 
it is strikingly contrasted with the strictly cerebro-spinal nerves. 

* Lobstein, Structure, Functions, and Diseases of the Human Sympathetic Nerve, 
f Physiological Anatomy, Chap. xxi. 



40 AN INQUIRY INTO THE 

It consists of an uninterrupted chain of ganglia, extending on 
each, side of the vertebral column from the first cervical vertebra 
down to the coccyx, and moreover extending upwards beside the 
cranial vertebrse, and occupying spaces between the bones of the 
cranium and those of the face. The continuity of this chain is pre- 
served by cords of communication which pass from one ganglion to 
another ; the chains of opposite sides communicate with each other, at 
various parts, in the plexuses of nerves which originate from them. 
The ganglia are sometimes divided for convenience of study into cra- 
nial, cervical, dorsal, lumbar, and sacral, each of these regions, con- 
taining a number generally corresponding to the number of the ver- 
tebrae in each. From each portion, certain sets of nerves may be 
traced ; these are, omitting the cords of communication between 
the ganglia — 1st. Visceral nerves, which generally accompany 
branches of neighbouring arteries to the viscera ; 2d. Arterial nerves, 
apparently devoted to arteries in the vicinity of the ganglia; 
3d. Nerves of communication with the cerebral or spinal nerves, 
which emerge from the cranium or spine, near the ganglia. The 
visceral and arterial branches have a remarkable tendency to form 
intricate plexuses, which entwine around the bloodvessels, and 
the visceral branches are conducted by these vessels into the tis- 
sue of the viscera. Of the branches of communication, it is suffi- 
cient to say, that they connect the ganglia with the cerebro- 
spinal system of nerves by means of two different sets of fibres, 
which are called its white and gray roots. The gray root appears 
to connect the ganglia of the sympathetic nerve to the ganglia on 
the posterior root of the spinal nerve, while the white root appears 
to be a branch coming from the spinal nerve, and to receive an equal 
amount of fibres from its anterior and posterior roots. These fibres 
may be seen in every instance spreading out upon the adjacent 
sympathetic ganglion, passing through the vesicular matter of which 
it is composed, and following the course of the trunk of the sympa- 
thetic for a longer or shorter way, and then proceeding from it in 
connection with the gelatinous fibres chiefly, to supply the viscera. 
These fibres are regarded as branches of the spinal nerve, which are 
distributed in connection with the gelatinous fibres, which are con- 
sidered the true and proper sympathetic fibres, and are derived from 
the ganglia. Carpenter* speaks of the cerebro-spinal fibres passing 
into the sympathetic, and the sympathetic fibres passing into the 

* Principles of Human Physiology, p. 558, ed. 1853. 



NATURE OF TYPHOIDAL FEVERS. 41 

cerebro-spinal nerves at their roots. From the above, it would ap- 
pear then that the sympathetic system consists in its intimate struc- 
ture of two distinct kinds of fibres, viz. those which come from the 
spinal system of nerves and also of the true sympathetic fibres, 
which are called gelatinous, and are peculiar to this system, and 
which originate from the vesicular matter of the ganglia. 

Thus constituted, the sympathetic system is found located as above 
described, in the various parts of the organism. In the head, four 
or five ganglia which are connected together by filaments ; these are 
the ophthalmic ganglion which is situated in the orbit on the outer 
side of the optic nerve ; from this ganglion which is in close connec- 
tion with the third or motor nerve of the eye and also with the nasal 
branch of the fifth nerve, a sensory nerve, proceed various branches 
of distribution to the eyeball, under the name of ciliary nerves. 
This ganglion has a third root by which it is brought into connection 
with the superior cervical ganglion. 

The other ganglia are the spheno-palatine, situated in the pterygo- 
maxillary fossa ; like the lenticular ganglion, and indeed like every 
other sympathetic ganglion wherever found, it is connected with a 
cerebro-spinal nerve, viz. the superior maxillary or second division 
of the fifth pair, a sensory nerve, by two small branches, which 
join it from above. This ganglion distributes branches in a great 
variety of directions, but those which we describe as most nearly 
connected with our subject, are the three palatines, anterior, middle, 
and posterior — to the mucous membrane of the hard and soft 
palate, uvula, and to the nasal mucous membrane ; the spheno- 
palatine — to the mucous membrane of the spongy bones and that of 
the septum. Also the Vidian or pterygoid branch, one branch of 
which enters the cranium and connects itself with a swelling on the 
portio dura, and another becomes a part of a plexus which surrounds 
the carotid artery, and finally is connected with the superior cervical 
ganglion. 

The Otic ganglion is situated on the inner border of the foramen 
ovale near the inferior maxillary nerve. It is very plainly a sym- 
pathetic ganglion as shown by its structure, for in this we find the 
vesicles as well as the tubular and gelatinous fibres very distinct; in- 
deed, it is often selected as a specimen for the microscope on this 
account. This ganglion is connected with the third division of the 
fifth nerve, which nerve is both sensory and motor in its function. 
This ganglion gives off various branches, some of which supply the 
cavity of the tympanum. It has also another branch which connects 
4 



ifl AM INQUIRY INTO THE 

it with the glosso-pharyngeal. which is distributed to the glci: 
follicles, and mucous membrane of the tongue. The last one of the 

ial ganglia which we will describe is the subn. 
in the substance of the submaxillary gland : it is connected with the 
gustatory branch of the fifth nerve, a nerve of special sensation, 
and its branches are distributed to the submaxillary and sublin_ 
glands and their ducts. 

The fw -t tiiree in number, called superior, mid- 

dle, and inferior. The superior, situated at the upper part of the 
cervical portion of the column, is connected by large branches with 
the first, second, and third spinal nerves. It sends branches up into 
the carotid canal, which divide and subdivide in such a manner as 
to form a complete plexus around the artery, which is called the 
carotid or cavernous plexus. With this plexus, there are numerous 
communi: stums : one which we particularly mention, which goes to 
issist in forming the tympanic plexus : so here again it will be per- 
ceived that the internal auditory apparatus receives ■ supply of 
sympathetic filaments. Branches also accompany the various rami- 
fications of the internal carotid artery in its distribution within the 
cranium. Communications exist between the various parts of the 
eighth and ninth pairs and this ganglion, and also a large trunk con- 
ta it with the middle cervical ganglion. Its visceral and arterial 
branches are those which supply the pharynx by forming the pharyn- 
geal i with the branches of the glosso-pharyngeal and tagna ; 
also a few filaments to the larynx accompanying the laryngeal branch 
of the vagws. The most important branches from the second and 
third : :■: : i »anfflia are those lar^e branches which, together with 
a smaller and more variable branch from the super!:, ganglion, serve 
I supply the hearty 'pally, with its innervation, under the name 
of superior, middle, and inferior cardiac nerves, which form plexuses 
under the name of cardiac, for the supply of this >rgan and of the 
aorta, some of them going to assist in forming the pulmonary plexus 
I supply the tangs. 

portion of the sympathetic system :■ insists if i - 
of ganglia corresponding very nearly with the number of the verte- 
brae ; these communicate freely with each other and also with the 
roots of the spinal nerves. They send branches to supply the aorta, 
which form the aortic plexus, and servf to constitiitc several large 
branches called the greater and lesser splanchnic nerves ; they pi 
the diaphragm, the former joining the great semilunar ganglion, and 

latter the renal and aortic plexuses. The lu 1 sacral 



NATURE OF TYPHOIDAL FEVERS. 43 

'portions of the sympathetic are connected with the dorsal or thoracic 
portion, sometimes by a small intercommunicating cord between the 
last dorsal and first lumbar ganglion and sometimes by the lesser 
splanchnic nerve. They, like the above, have numerous and very 
distinct communications with spinal nerves, and form plexuses for 
the supply of some of the abdominal and of the pelvic viscera, to- 
gether with the lower portion of the aorta under the name of inferior 
aortic plexus. 

In addition to the above ganglia, which are usually denominated, 
from their location and close connection with the general nervous 
system, the spinal or vertebral sympathetic ganglia, there are 
others of not less, and by some authors considered of infinitely 
more importance ; we refer to the isolated ganglia, situated within 
the thoracic and abdominal cavities, and which appear to have com- 
paratively but little direct and intimate connection with the cerebro- 
spinal system or with the external parts of the organism, and to be 
devoted to the viscera entirely, and therefore are with their branches 
pre-eminently entitled to the denomination of visceral ganglia and 
nerves. These are found in various situations, several of them in 
connection with the various cardiac plexuses,* but the most important 
are found in the abdominal cavity forming the centres of the solar 
plexus, under the names of greater and lesser semilunar ganglia : 
from these pass off plexuses accompanying and corresponding in 
name with the various branches and sub-branches of the coeliac axis, 
and conducted by them into the organs, for which they are mani- 
festly intended. Todd and Bowman thus describe these plexuses : 
" The nervous plexuses of the abdomen are extremely complicated 
and numerous. They are principally derived from two great ganglia, 
situated, one on either side of the coeliac axis, in front of the aorta. 
These ganglia are semilunar in shape, convex downwards and out- 
wards; they unite below the coeliac axis; and chiefly from the 
convex border, a vast radiation of plexiform nerves takes place, 
which follow the course of and entwine around the branches of the 
coeliac axis, and other branches of the aorta. To this great radiator, 
anatomists have given the name of solar pleztis, and the conjoined 
semilunar ganglia must be looked upon as the great centre — the 
sun of the abdominal sympathetic system." 

* Several ganglia are found in connection with the nerves of the heart. Wris- 
berg describes one near the arch of the aorta, and Remak describes and figures seve- 
ral among the anterior and posterior cardiac plexuses, and in the substance of the 
heart. — Todd and Boivman, p. 505. 



44 AN INQUIRY INTO THE 

From this solar plexus proceed subdivisions or smaller plexuses, 
corresponding with the arterial trunks in this region, as the diaphrag- 
matic plexus, a small network accompanying the phrenic arteries, 
and the supra-renal arteries. 2d. The coronary or gastric plexus, 
which assist with the pneumogastric nerve in the supply of the sto- 
mach. "Of these filaments," says Cruveilhier, "some ramify upon 
the cardia, while the remainder follow the coronary artery along the 
lesser curvature of the stomach. It follows, therefore, that the 
stomach is principally supplied by the pneumogastric nerve. The 
cardia and the lesser curvature of the stomach are the parts which 
are the most abundantly supplied with nerves. The pylorus, to which 
we attribute such great sensibility, has incomparably fewer nerves."* 
To the liver there are sent, in great profusion, branches, from this 
great plexus, which constitute the hepatic plexus, the branches fol- 
lowing the course of the arteries, and being conducted by them into 
every portion of the intimate tissue of the organ. For the spleen 
there is the splenic plexus, and so likewise the renal plexus for the 
kidneys ; though this last, together with the inferior mesenteric and 
spermatic plexuses, are not so directly offsets from the solar plexus, 
being more distinct from it than those above described. 

Lastly, as most intimately connected with our subject, we describe 
more fully the superior mesenteric plexus, which supplies the greater 
portion of the intestinal canal, accompanying the ramifications of the 
superior mesenteric artery to wherever these are distributed. Find- 
ing the most concise, and, at the same time, most pertinent descrip- 
tion of this plexus in Cruveilhier's Anatomy, we prefer to use his 
words : " The superior mesenteric plexus, which may be regarded as 
the lower division of the bifurcation of the epigastric plexus, is the 
largest of all the abdominal plexuses ; it surrounds the superior me- 
senteric artery, forming an extremely thick plexiform sheath for it ; 
it passes below the pancreas, enters the substance of the mesentery 
with the artery, and divides, like that vessel, into a great number of 
secondary plexuses, which are distributed to all parts supplied by 
the artery, namely, the whole of the small intestines, excepting the 
duodenum,^ and right portion of the great intestine. 

One more point in relation to the anatomy of the nervous system 
in reference to this subject, and we have done ; we refer to the very 

* Treatise on Human Anatomy, p. 867, and marginal note. 

| Dr. Todd, in the Cyclopaedia of Anatomy and Physiology, says that the duodenum 
is supplied by the cerebro- spinal system of nerves. 



NATURE OF TYPHOIDAL FEVERS. 45 

close connection that exists between the ganglionic system, and the 
pneumogastric or par vagum nerve; both in the substance of the lungs 
and in the superior cervical ganglion,* as well as in its relations to 
the semilunar ganglion, so close is this latter connection, that some 
authors have even regarded the whole nerve as originating from this 
ganglion, f a surmise which, we must admit, is altogether unfounded; 
but still, it serves to show the character of this connection, as well as 
in some measure the character of function attributed to this nerve. J 
Dr. John Bird, in his experiments on the nerve, found that its section 
produced, besides other symptoms, a peculiar congestion of the lungs, 
resembling pneumonia, which congestion was, no doubt, attributable 
to the cutting off from the lungs the supply from the sympathetic 
system. This, then, brings us to a consideration of the functions of 
the sympathetic system. 

In the physiology of the nervous system, if there is one fact better 
established than another, it is, that the ganglionic system, whatever 
else may be its functions, presides over and controls the important 
act of circulation, secretion, and nutrition; or, at least, forms a ne- 
cessary element in these functions. Anatomy, both special and 
transcendental, as well as vivisections and physiological experiments, 
all serve plainly and incontestably to demonstrate this fact in relation 
to its office. " Clinging to the coats of the arteries, it follows them, 
for the most part, in their ramifications, and attaches itself to them, 
as the ivy does to a tree." It seems to be nerve of the bloodvessels, ' 
and as, remark Todd and Bowman, "secretion is mainly dependent 
on the normal nutrition of glands, it is reasonable to suppose that 
that function would be, to a certain extent, controlled by these 
nerves." Dr. T. B. Proctor, in a very sensible treatise on the sympa- 
thetic nerve, says : " It is quite clear, from the important and inter- 
esting experiments made by Wilson Philip, Legallois, and Pleurens, 

* Todd & Bowman, pp. 488 and 502, Physiological Anatomy, American edition. 

f "I am perfectly aware," says Dr. James George Davey, of London, "that Dr. 
Stevens maintains both the vagus and spinal accessory nerves derive their origins 
not from the medullse oblongata, but from the upper part of the semilunar ganglion. 
But I cannot think so." — Vide Ganglionic System, London Lancet, vol. for 1851. 

j This nerve, from the resemblance in its functions to the sympathetic, has been 
called the lesser sympathetic nerve, and it is remarkable that, in that class of ani- 
mals in which the sympathetic is said to be deficient, or nearly so, its place is supplied 
by the pneumogastric. 

"In the cyclostomes among fishes," says Wagner, "the sympathetic is either wholly 
or in major part, replaced by the par vagum; the same thing occurs among serpents." 
— Elements of Special Physiology, p. 514, 



46 AN INQUIRY INTO THE 

that neither the brain nor nerves of the spine have anything to do 
with the circulation of the blood ; as it could be seen that animals 
lived for some time, and the circulation went on with vigor, after the 
brain and spine had been removed, separately, and also conjointly. 
It is self-evident, then, that it is to the sympathetic (and to that 
alone) that we must look as the regulator of the arterial system. And 
it will be observed that, in all parts of the animal body where large 
and sudden supplies of blood are required, such as the heart, stomach, 
bowels, and organs of generation, we have the sympathetic or 
ganglionic system very fully developed, and as far as I can judge, 
in ratio to the amount of blood supplied to these several organs. On 
the contrary, in some parts of the body, and in the extremities, where 
the flow of blood is more regular, and not subjected to those sud- 
den calls for large supplies of blood at irregular periods, we find 
this nerve manifestly decreasing in size ; and, indeed, as far as we 
can judge with the naked eye, ceasing altogether in some parts. Still, 
I perfectly agree with Sir Charles Bell, that it is distributed all over 
the body ; but whether its influence is confined to regulating the 
small vessels which supply the coats of the arteries, or whether the 
same influence is continued by it over the whole circulating medium 
of the extremities and other parts that it manifestly exerts over the 
abdominal viscera, must, I fear, be left to a more enlarged inquiry."* 
Dr. Carpenter, who believes somewhat differently from the above, 
and, with most physiologists of the present day, namely; that the 
sympathetic nerve derives whatever of sensory and motor power it 
possesses from the anterior and posterior column of the spinal cord, 
expresses himself in the following apposite manner injegard to the 
functions of the sympathetic as a whole. "It seems fair to conclude 
that the motor power of the sympathetic system — which is chiefly 
exercised on the muscular substance of the heart and tvalls of the 
bloodvessels, on the muscular coats of the alimentary canal, and of 
the large gland-ducts which open into it, and on the muscular walls 
of the genito-urinary organs — is entirely derived from the cerebro- 
spinal system. In no instance, however, can the willf exert any in- 

* Medico-Chirurgical Review, Jan. 1845, also Treatise, separate, p. 21. 

■j- We do not wish to deny this assertion ; but there is on record one familiar case, 
which would appear at first sight strongly contradictory of this statement, that of 
Col. Townsend, who is said to have had such entire control over the action of his 
heart that he could make it cease to beat at any time, and virtually die, and live 
again, so far as the circulation was concerned, at will ; but, on one occasion, having 



NATURE OF TYPHOIDAL FEVERS. 47 

fluence over the movements of these parts; they are strongly affected 
by emotional states of the mind, and they frequently seem to respond 
to impressions made on remote organs. If, then, the sensori-motor 
endowments of the sympathetic trunks be restricted to those fibres 
which are really cerebro-spinal in their origin or termination, it re- 
mains to inquire what are the functions of the true sympathetic 
fibres, whose vesicular centres lie in the ganglia of the sympathetic 
system. Upon this point, we can only surmise ; but there appears 
strong grounds for the" conclusion, that the office of these fibres is to 
produce a direct influence upon the chemico-vital processes concerned 
in the organic functions of nutrition, secretion, &c. ; an influence 
which, although not essential to the performance of each separate 
act, may yet be required to harmonize them all together, and to 
bring them into connection with mental states."* 

Sir Charles Bell'sf opinion is somewhat similar. " We are left to 
the conjecture that the sympathetic or ganglionic system of nerves, 
according to Bichat, are for those thousand secret operations of a 
living body, which maybe called constitutional: circulation, secretion, 
and absorption, are operations which simultaneously affect the entire 
frame." 

From the above, then, it appears that the sympathetic system, as a 
whole, being composed of intrinsic gelatinous fibres and cerebro- 
spinal or tubular fibres, has two distinct and separate offices to per- 
form in the animal economy, viz. 1st, by virtue of its cerebro-spinal 
or tubular fibres, to preside over the movements and sensations (what 
little they possess) of the heart and other involuntary muscles, as the 
muscular coats of the intestines, bladder, and the coats of the various 
excretory ducts ; and that it is the source of intrinsic motory power 
to the bloodvessels, these depending upon this system for their innerva- 
tion; and, secondly, that by its vesicular and gelatinous portions, it 
presides over the chemico-vital operations of the animal organism, 

willed himself to death for the amusement of some friend, he carried the experiment 
too far, and life became extinct. 

This peculiarity was probably due to an unusually large supply of filaments from the 
pneumogastric and spinal nerves, as is very frequently observed in dissections, or as we 
would now suggest, it was attributable to disease of those fibres of the sympathetic 
which belong essentially to it, and of the ganglia, by which disease those parts had 
lost their isolating poiver, so that the cerebro-spinal influence, over which the will pre- 
sides, was transmitted unembarrassed to the heart. This case certainly should not 
detract from the force of Dr. Carpenter's remarks. 

* Principles of Human Physiology, 1853, p. 830, et seq. 

f On the Nerves, p. 11. 



48 AN INQUIRY INTO THE 

concerned in digestion, secretion, absorption, &c. &c. In a few 
words, then, it presides over the functions of all the involuntary 
muscles, and controls circulation and secretion. 



PATHOLOGICAL DEDUCTIONS. 

Having thus carefully recounted the more important features in 
the anatomy and physiology of the sympathetic system, it remains 
but to consider them in connection with the phenomena of typhoidal 
fevers. Such a review will be attended with the following results. 
In the first place, the essential symptoms of typhoid fever are located 
in organs deriving their innervation principally, and in many instances, 
entirely from the ganglionic system : In the organic or involuntary 
muscles — as for instance the heart's — of which, during life, we find 
the frequency increased, the force diminished, and the regularity im- 
paired — all of which effects must be plainly attributable to the al- 
tered innervation of the organ. After death, we have seen it the 
subject of very material alteration ; its substance is flabby, pale, and 
much softened, so that it breaks readily under the fingers. Instance 
again, the muscular coat of the intestine ; we have meteorism — an 
almost invariable symptom in typhoid fever — and which we may 
legitimately refer to the loss of tonicity in the muscular coat of the 
intestinal canal, from impaired innervation of that coat, by which 
condition, together with the altered state of the secretory surfaces, 
the passive accumulation of gas in the intestines is allowed, and 
hence the tympanites. 

That this altered condition in the innervation of the organic mus- 
cular fibre does exist, is shown most remarkably in the mode of dying 
in some cases, viz., that mode termed asthenia, "occasioned by causes 
acting directly on the circulatory forces, affecting the vis nervosa, 
upon which the contractile property of the heart depends,"* and far- 
ther, that this depression in the involuntary muscles has no invariable 
correspondence in the state of the voluntary muscular system ; as we 
shall find remarkably illustrated in the observations of Dr. Flint, f 
" In some of the cases attended with most danger, and some of them 
ending fatally, the muscular strength was retained in a surprising 
degree. In two fatal cases of the typhoid type, characterized by 
active persistent delirium, the muscular efforts were almost constant 
and quite strong up to a few hours before death. One of these cases 

* Flint, p. 125. f Reports on Continued Fever, p. 59. 



NATURE OF TYPHOIDAL FEVERS. 49 

terminated on the ninth day, and the other on the third day after 
coming under observation. The mode of dying in each was by asthe- 
nia, or, perhaps, more properly, necroemia ; the system of involuntary 
muscles exhibiting reduction of force to a degree incompatible ivith 
life — the voluntary muscles remaining active. This is a curious 
fact." 

This relative condition of the voluntary and organic muscular sys- 
tems, appears to impress even the observing and philosophic mind of 
Dr. Flint as almost inexplicable ; and it is not surprising that it 
should, when we consider that his views of the pathology of typhoid 
fever have no fixed or definite reference to the organic system of 
nerves ; but, on the admission of the ganglionic pathology of the 
disease, the full interpretation of these phenomena, besides many 
other similar facts (meteorism) before inexplicable, become easy and 
natural. 

II. Besides the organic muscular system, which we have just shown 
to be under the influence of ganglionic nervous aberration, we find 
that the other characteristic phenomena of typhoid fever refer to the 
functions of nutrition and secretion, both of which important pro- 
cesses depend upon the vascular system, w T hich, especially in the 
viscera, are admitted to be under the sole dominion of the sympa- 
thetic nerve. And, what is more remarkably illustrative of this 
fact, is, that there appears to be a very close relation between the 
amount of disease observed in any particular portion of the organism 
— the alimentary canal for instance — and the degree to which it is 
indebted to the ganglionic system for its innervation; thus we find 
but a small amount of disease, congestion, seldom any ulceration, in 
the larynx ; ulceration is somewhat more common in the pharynx, 
oesophagus, and stomach, though still not abundant. It disappears 
in the duodenum, which receives but few sympathetic filaments, and 
again appears in the upper portion of the ileum, increasing, as we 
descend, in direct proportion to the amount of ganglionic fibres the 
part receives, till it reaches its maximum in the lower portion, where 
the nervous supply is very abundant ; after which, we find ulceration 
occasionally in the ccecum, still less frequent in the colon, till in the 
rectum, whose innervation is principally from the cerebro-spinal sys- 
tem, it is never observed. So, likewise, with regard to the other 
organs ; we find the liver, lungs, and spleen are all subject to con- 
gestions, which can be referred to the same abnormal innervation of 
these viscera. 

From the relative unfrequency of disease in certain portions of 



50 AN INQUIRY INTO THE 

the abdominal viscera, and elsewhere, Louis, as we have seen, though 
admitting their diagnostic importance, is disposed to view them as 
results, secondary to the lesion in the ileum ; we cannot, however, 
agree with him, but are compelled to regard them as the common 
primary results of a common cause which exists in the ganglionic 
system, and that the frequency or the gravity of disease in any 
one of these organs is determined alone by the amount to which the 
ganglionic ingredient mixes with, or enters into its innervation, and 
that disease in these localities has no etiological reference whatever 
to that in the ileum : but, when it exists, is as significant of the true 
pathology as is the ileitis — for it invariably indicates, both by its 
location and character, that its origin is abnormal innervation. 

So far then as regards the localities in which the manifestations of 
typhoid fever occur, we have found an exact correspondence with 
the distribution of the sympathetic nerve, as likewise between the 
amount of disease and the proportion of this kind of innervation in 
any given parts. Now it will be our object to examine carefully, in 
order to ascertain if there is any analogy between the character of 
these typhoidal phenomena, and of those results which have been 
obtained by experiment upon this system of nerves. In this inte- 
resting department of physiological inquiry, there have been many 
engaged, but a few will answer very well the purposes of our com- 
parison. As early as the year 1732, Pomfour du Petit found that 
the division of the trunk of the sympathetic, opposite the fourth or 
fifth cervical vertebra in dogs, was very rapidly followed by great 
disturbance in the circulation of the eyeball, producing inflammation, 
flattening of the cornea, retraction of the eyeball, with protrusion of 
a fold of the conjunctiva and &flow of tears, and ultimately ulcera- 
tion and destruction of the organ. The experiments of Dupuy upon 
horses, wherein he extirpated the superior cervical ganglion, were 
followed by the same results with regard to the local effect in the 
eye, but also, with the more opposite and corroborative consequences, 
that there was an eruption over the whole cutaneous surface, with 
emaciation and an ©edematous state of the limbs. Dr. John Reid, 
has also experimented on the sympathetic nerve in the neck, and 
found the eye similarly affected with the above, the conjunctiva be- 
coming red and congested in a few minutes, while in other experi- 
ments* the eye presented an ecchymosed or bloodshotten appearance. 
Each one of these conditions of the eye must be borne in mind, in 

* Arneman's Experiments on Nerves. Gottingen, 1787. 



NATURE OF TYPHOIDAL FEVERS. 51 

order to appreciate the comparison ; inasmuch as, on account of the 
great difficulty of making such experiments on other portions of the 
sympathetic system, we can find none on record which will serve as 
reference; for it will readily appear that, from the remote position 
of these nerves, it is impossible to make their section without so mate- 
rially deranging other important parts of the organism as to render 
the results valueless in deduction. 

Now, a reference to some of the pathological phenomena of typhoid 
fever, will discover a close analogy, if not identity to the above 
results ; in the first place, the conjunctival congestion ; its character, 
the attendant suffusion, together with the entire freedom from pain, 
even on exposure to the strongest light; while, at the same time none 
of the symptoms of true inflammation are present ; all indicate the 
seat of the nervous derangement upon which it depends to be the 
ganglionic system* and not the cerebro-spinal, the analogous de- 
rangements of which are invariably of a sthenic character, and 
attended with acute pain in the region in which they occur. Again, an 
attentive consideration of the character of these congestions will 
show that it does not vary in any respect, except in degree, whether 
occurring in the mucous membrane of the eye, that of the stomach, 
pharynx, small intestine, large intestine, or bladder, in the typhoid 
type, or on the cutaneous surface in the typhus. In all the above lo- 
calities, and under all circumstances, we find the capillary congestions 
wearing the same aspect, assuming invariably a passive character, 
often approaching the condition of true stasis, but never attended 
with the florid redness, the pain or the swelling of active inflamma- 
tion. Lastly, in the cutaneous petechial eruptions or maculae of the 
typhous type of continued fever, we can also detect the same character 
of passive congestion from deficiency of nervous energy carried to a 
still greater degree ; in this type, the nervous power of the cutaneous 
capillaries is so far diminished, that it amounts to a state of actual 
paralysis, allowing such distension of the capillaries that their rup- 
ture and a subcutaneous effusion is the result. 

We have thus far endeavoured to show that typhoidal fevers result 
from alterations in the condition of the ganglionic nervous system ; 
first, by comparing the typhoid phenomena with the normal action 

* Dr. A. Billing remarks, in relation to this subject: "Without, therefore, at present 
seeking for farther proofs, I deduce from blushing, and from the effects of electricity, 
fire, and cantharides, that the capillaries are dependent upon the nervous system for 
that tone or energy which preserves them from over-distension." — The First Prin- 
ciples of Medicine, p. 44. 



52 AN INQUIRY INTO THE 

of the sympathetic system, and we have found that the analogy is 
complete, and that typhoid phenomena are but the result of aberra- 
tions in the normal action of these nerves. Their action may be either 
exaggerated or diminished ; for instance, a portion of this system 
controls the action of the heart, and in health endows this organ 
with a frequency of action amounting to 60 beats per minute in the 
adult ; and without disturbing causes, this number will continue un- 
varyingly in its regularity till the close of life. But we know that 
this regularity is liable to many interruptions and disturbances ; some 
of them but momentary, as from the emotions ; others disturb it for 
many hours by increasing its frequency, as in paroxysmal fever ; and 
lastly, in typhoid fever, we find this increase of frequency kept up for 
many weeks, but still retaining the remarkable feature of continuous- 
ness, which distinguishes the normal action of the sympathetic system 
from that of the cerebro-spinal system, which is intermittent in all 
its phenomena, whether normal or abnormal. Were we now requested 
to explain the difference which marks the increased frequency of 
pulse in these three instances ; to answer why is it evanescent in 
one case; of but a few hours' duration in the second; and yet con- 
tinue many weeks in the case of typhoid fever? — we think, we 
should do it thus : The heart, being under the dominion of the 
ganglionic system, performs its normal action through its influence ; 
but from the intimate connection between the sympathetic and cere- 
bro-spinal systems, especially in this organ, it is very liable to be 
affected by emotional causes acting in the brain ; these, of course, will 
be evanescent ; or it may be affected by causes acting in the spinal 
marrow, which may be more durable, as would be the case in a 
paroxysm of intermittent fever ;* but it will be observed that, in 
these cases, the organic system is only secondarily implicated, and so 
soon as the mental emotion subsides, or the spinal irritation is re- 
moved or has exhausted itself in a paroxysm, the excitor being with- 
drawn, the sympathetic becomes again normal, and the action of the 
heart consequently natural. But in continued fever, the case is quite 
different ; the irritation is now located in the ganglionic centre itself, 
which supplies the heart, and consequently the increased frequency 

* We have adopted the pathology of intermittent fever advocated by Maillot, viz. 
that it consists in cerebro-spinal intermittent irritations. Prof. J. F. Lobstein re- 
marks: "The paroxysms of intermittent fever are tied down to a regular rhythmus, 
in consequence of being radicated in the nervous system, upon which nature has im- 
pressed a law according to which they must perform their functions periodically. — 
Sympathetic Nerve, p. 121. 



NATURE OF TYPHOIDAL FEVERS. 53 

continues as long as this irritation remains, which is coeval with the 
duration of the disease. There is one feature of continued fever, to 
which, heretofore, we have seen no satisfactory explanation that 
we think can be accounted for rationally according to the pathology 
here suggested ; we refer to the paroxysms and excerbations which 
frequently complicate the course of continued fever. We would attri- 
bute these paroxysms to the extension of the irritation from the gan- 
glionic to the cerebro-spinal centres, and we conceive that it is only 
under such circumstances that we find these intercurrent paroxysms 
masking the course of the typhoid affection. By this means there is 
effected a true blending of types from a blending of proximate causes, 
and the two sets of phenomena exist in combination ; a continued 
fever characterized by paroxysms of exacerbation. In the same 
manner, on the other hand, can we conceive of paroxysmal fever be- 
coming continued under favourable circumstances, by the transmission 
of irritation from the cerebro-spinal to the ganglionic system. 

As the abnormal innervation in the sympathetic system can pro- 
duce a continued accelerated action in the heart, in typhus and 
typhoid fever, so, likewise, can the diarrhoea of the typhoid type be 
shown to be a result probably of a similar condition. The normal 
action of the ganglionic system endows the intestinal canal and other 
viscera with the function of healthy secretion ; but during the exist- 
ence of the typhoid state this proper action is destroyed ; in place of 
the organs being the seat of a normal and proper circulation, which 
is necessary for the due exercise of their function — secretion, the 
vessels become the seat of obstructions and congestions, the secretions 
become more abundant, but abnormal and vitiated; we have then diar- 
rhoea. As these congestions become more marked, we find the para- 
lyzed and over-distended vessels giving way, allowing submembranous 
effusions of blood, and occasionally considerable hemorrhages — all 
being the result of the altered condition of the innervation of these 
organs. Thus, what in its beginning was a purely dynamical affec- 
tion, soon becomes organic ; for without the proper supply of gan- 
glionic nervous influence, we have seen, from the above-mentioned 
experiments, that the circulation ceases, the capillaries become tur- 
gescent, especially in highly vascular secretory organs (as the mucous 
surfaces, or the glandular plates of Peyer, for instance), effusion of 
lymph takes place, and, as above stated, finally, the capillaries are 
ruptured, and the tissues in certain places rapidly disintegrate by 
the process of ulceration — which is the actual condition of things in 
the intestinal disease of typhoid fever. 



54 AN INQUIRY INTO THE 

From wliat has already been said in relation to the distinctive 
features of the two types of continued fever — -typhoid and typhus, 
their interpretation, according to the pathology herein argued, will 
have been, doubtless ere this, naturally suggested. We have seen 
that typhoid fever is marked by an accelerated pulse, more or less 
nervous derangement, an altered condition of the blood, frequently a 
mild cutaneous eruption, diarrhoea, and meteorism. On post-mortem 
examination, we find lesions ; viz. congestions and ulcerations of a 
peculiar character, that is, simulating those produced by experimental 
sections of the nerves in all those parts supplied by the visceral por- 
tions of the ganglionic system of nerves. On the other hand, we 
have seen that typhus fever is characterized by a somewhat more 
accelerated pulse, much more marked nervous derangement, the same 
altered condition of the blood, well-marked and always serious alter- 
ations in the capillary circulation of the skin, amounting often to 
actual ecchymosis, while the post-mortem examination shows almost 
entire exemption from lesion in the abdominal viscera. Thus, we find 
that while both diseases have all their general symptoms so exactly 
similar that we are forced to acknowledge their identity, and see in 
them what is essentially but one disease, yet typhoid fever has its 
principal and most prominent manifestations in the abdominal viscera 
— internally ; and typhus fever manifests itself in aberrations of the 
circulation, very analogous to those of typhoid, but occurring in the 
capillaries of the cutaneous surface. 

Now the ganglionic pathology is the only theory by which such 
marked incongruities in the two forms of what, to the observation 
and scrutiny of every one, must ever appear as one disease, can be 
perfectly and satisfactorily reconciled. We cannot deny that the two 
are but types of the same disease ; yet how incongruous and strange 
it is that, in certain cases (typhoid), diarrhoea and intestinal lesion 
should appear the main — the most important features ; while in the 
other cases (typhus), undeniably of the same disease, even more 
grave and threatening, there should be not a trace of diarrhoea, and 
on post-mortem examination no intestinal lesion whatever, but, in- 
stead, serious disease and congestion of the shin, with subcutaneous 
sanguineous effusions, similar to the submembranous sanguineous 
effusions of the typhoid type. Indeed, from the very smallest 
degree of attention must result the conclusion that, in the two cases, 
the disease is one and the same, but seated in different portions of 
the organism ; and this conclusion will accord exactly with what we 
have considered the distinctive pathology of the two forms, viz. 



NATURE OF TYPHOIDAL FEVERS. 55 

that in each type the disease is located in a different portion of the 
ganglionic system. There are certain parts of the system which are 
affected in both forms of the disease — as the ganglia supplying the 
heart ; but after this, the two types have entirely distinct and sepa- 
rate sets of ganglia, the morbid action in which gives rise to their 
respective manifestations. In typhoid fever, the internal or visceral 
isolated ganglia, such as the semilunar, &c, are the seat of the mor- 
bid action ; and these supplying mainly, we may say entirely, the 
abdominal viscera, and having but little connection with the other or 
external portions of the organism, these viscera become the seat of 
nearly all the morbid phenomena ; while that little implication of 
the cutaneous surface and general nervous system, which we often 
observe, is entirely due to the remote and very obscure connection 
which their isolated ganglia may have with the nerves supplying 
these parts. 

Now, in the typhus type, the same disease, or morbific agent (its 
exact nature we do not pretend to define), affects an entirely different 
set of nervous centres — a set of ganglia which, by their anatomical 
position, their internal and universal relations with the anterior and 
posterior roots of the spinal nerves, are plainly destined to preside 
over the capillary circulation of parts more superficial — the cutaneous 
surface. We have reference to the vertebral sympathetic ganglia ; 
and, in attributing the location of typhus fever to these ganglia, we 
have a ready and satisfactory interpretation of all its distinctive 
characteristics. The skin becomes congested and ecchymosed (pete- 
chial), because its circulation is dependent upon and controlled by 
innervation derived from these vertebral ganglia; which ganglia 
being the seat of abnormal action (perhaps paralysis), innervation is 
deficient, the cutaneous circulation is retarded ; in certain places there 
is obstruction, with actual rupture and effusion, giving rise to pete- 
chia. The general (cerebro-spinal) system is more seriously involved 
in typhus than in typhoid fever, because the connection is more direct 
between the vertebral ganglia — which are the seat of typhus — and 
the cerebro-spinal system. In a word, then, we would locate typhoid 
fever in the visceral portion of the ganglionic system, and typhus in 
the vertebral portion. 

We are fully aware that our views of the pathology of typhoidal 
fevers would be greatly corroborated, could there be discovered any 
appreciable lesion in the ganglionic nervous centres, in subjects who 
have died during their progress ; but, like the pathological anatomy of 
all the nervous system, this would be an investigation attended with 



56 AN INQUIRY INTO THE 

many difficulties ; for histological changes in the nervous centres 
are of such a character that though they may be competent to sub- 
vert the intellect, entirely paralyze or destroy the functions of a 
large portion of the organism, and ultimately, upon the most positive 
rational evidence, seem to be the cause of death, yet on examination 
the alterations observable in those centres are of the most insignifi- 
cant and irrelevant character, pertaining only to the involucre, while 
the centres themselves, which, from the previous symptoms, had 
been plainly the true seat of the disease, have been found apparently 
normal and intact. These changes, then, are probably molecular 
and inappreciable with our present means of investigation, and will 
require years, and far more perfect appliances, to incorporate them 
among the positive and demonstrable things of our science. Still, there 
are occasionally isolated facts, even in the pathology of the ganglionic 
nervous centres, which we may refer to in corroboration of our 
opinion that these centres are affected in typhoidal fevers, and that 
such affection gives rise to its characteristic symptoms, or to pheno- 
mena quite analogous in their nature. The case reported by Pro- 
fessor Lobstein is of this nature. It was that of a young girl who 
had suffered from paralysis of the lower extremities for some time, 
but for three months previous to her death laboured under the most 
incurable diarrhoea with tormina, &c. On making a post-mortem 
examination, there was found a large abscess on the left side, extend- 
ing from the sixth to the tenth dorsal vertebra. On opening this 
abscess, it was found that the trunk of the left sympathetic nerve 
was entirely destroyed from the sixth to the twelfth vertebra, and in 
the lumbar portion the same nerve was in a state of inflammation.* 

There are also two -cases reported as occurring in the practice of 
Dr. Aronsshon, of the Strasburg Hospital : The first, that of a man 
forty-seven years old, affected with diarrhoea. He died of a tumour 
in the abdomen, and it was found that " the semilunar ganglia were 
affected with distinct inflammation." The second..case was a woman 
aged about thirty years, who, in her second pregnancy, was subjected 
to vomiting throughout the whole of her gestation. She was also 
affected with a furfuraceous eruption upon the breast and arms, with 
swelling of the limbs, and with diarrhoea. On a post-mortem ex- 
amination, the villous coat of the stomach was found inflamed and 
thicker than usual, especially towards the pylorus, " and the semi- 
lunar ganglia were found in a state of genuine inflammation." 

* Structure, Functions, and Diseases of the Sympathetic Nerve, p. 147. 



NATURE OF TYPHOIDAL FEVERS. 57 

" In the body of a boy ten years of age/' says Lobstein, " who 
had died from the retrocession of a miliary eruption, attended with 
symptoms of great anxiety, oppression of the chest, and distension 
of the epigastrium, I found a place in the left trunk of the inter- 
costal (which is the old name for the sympathetic) nerve, highly 
inflamed between the eighth and tenth ribs, with a phlogosis of the 
ninth and tenth thoracic ganglia, and their two anastomotic branches 
with the costal nerves." 

The following observations are quite pertinent to the state of con- 
gestion in which the lungs are almost invariably found, to a more 
or less degree, in typhoid and typhus fever. " On examining into 
the condition of the nerves in diseases of the lungs, I discovered 
another alteration which is peculiar to these organs; to wit, in that 
species of peripneumony, in which the lungs became red and slightly 
indurated* and which, I think, should be called spleenification ; the 
nervous filaments attending the ramifications of the bronchia were 
found equally red, a little more tumid, but much more tender than 
usual; so as to be broken by the slightest degree of force "^ And, 
lastly, the same authorj quotes a case still more in point, from the 
writings of Professor Autenrieth, of Tubingen, wherein it is asserted, 
though he does not appear to connect the circumstance with the 
pathology of the disease at all, that he has seen the abdominal 
nerves of the ganglionic system somewhat changed in subjects who 
have died of typhoid fever. 

The above cases, though not conclusive, are at least strongly cor- 
roborative of our view of the pathology of typhoid fever ; for while 
we must admit that the diarrhoea, the eruption, the pulmonary con- 
gestion, oedema, &c, might have been produced by other causes than 
disease of the ganglia found inflamed or divided, still, when these 
coincidental circumstances are viewed in connection with the known 
result of artificial section of accessible portions of the sympathetic 
nerve, as those about the neck and eye,§ and also in view of the 
entire dearth of experiments and facts bearing upon this portion of 
the ganglionic system, we must regard them as significant and valu- 
able, even though they afford what we may term only a legitimate 
suspicion of the correctness of our pathological views. 

* Exactly what is described by Dr. Flint as the pseudo-pneumotis of continued 
fever. 

f Lobstein, p. 139. % Op. cf*. p. 137. 

\ See experiments of Panfour du Petit, Dupuy, John Reid, and others, already 
referred to. 

5 



58 AN INQUIRY INTO THE 

We have now completed our investigations in relation to this 
intricate, but, at the same time, most interesting topic of pathological 
inquiry; we have reviewed its history, and collected from every 
source within our reach as complete a delineation of its prominent 
and characteristic phenomena as has been necessary for their full 
development. In so doing, we have been struck with the vast number 
of reliable and significant facts our science is in possession of, in 
regard to this disease. ISTo disease in the catalogue is more invari- 
able in its characteristic manifestations ; no disease has been more 
diligently studied, or has enlisted in its investigation such faithful 
observers. Our knowledge in regard to its observed phenomena and 
facts is clear, well defined, almost certain ; to complete the science 
in regard to it, it has but remained that these cognate, well-ascer- 
tained facts and phenomena be rationally and correctly interpreted, 
that its true pathology might be deduced. To this arduous, though 
not unpleasing task, not without many misgivings, we have earnestly 
and diligently devoted ourselves, more with the hope that our labours 
would prove suggestive to others of the true mode of arriving at 
the real pathology, than that we should be able to supply the want 
or remedy the deficiency. 

Starting with what we considered the rational assumption that the 
pathology of typhoiclal fevers is in the ganglionic system of nerves, 
we have compared their characteristic traits and phenomena with, 
first, the normal action of this portion of the nervous system, then 
with the known and well-established results of experimental irrita- 
tion and action of various portions of these nerves, and we have 
found that the analogy is sufficiently close to admit the legitimate 
inference that the symptoms and pathological lesions of typhoid and 
typhus fever are produced by a normal action in certain portions of 
this system of nerves. First, because no typhoid or typhus pheno- 
menon ever occurs, except in regions supplied by this system ; se- 
condly, because the peculiar phenomena of these diseases occur in 
a more marked degree, in those parts most abundantly supplied from 
this source ; and thirdly, because the nature of these symptoms are 
always found more purely and characteristically typhoid in those 
portions of the organism supplied exclusively by this kind of in- 
nervation. And farther, on the other hand, we are forced to admit 
the truth of these impressions, because we have hitherto had no 
theory or legitimate and consonant combination of theories, to our 
own mind, as competent to the full and rational explanation of all 
the phenomena of the disease as the one now offered. 



NATURE OF TYPIIOIDAL FEVERS. 59 

Practical Deductions. — Pathology is only valuable when it has 
a tendency to the prevention, amelioration, or cure of disease, and 
the results of our most successful labours in this department are but 
nugatory unless in them can be found a clue to a more rational and 
perfect management of the affections to which they refer. 

If the views embodied in the foregoing treatise are correct, the 
following practical inferences must present themselves as legitimate, 
if not inevitable : First, that in the management of this class of 
fevers the strictest attention should be paid to the improvement of 
the tone of the nervous system ; all depressing measures, or such as 
are calculated to exhaust the nervous energies, as depletion by pur- 
gation or otherwise, should be scrupulously avoided ; and secondly, 
that in their place means of an opposite character should be in- 
voked. Indeed, that treatment now most in favour, though but 
empirically* applied, will be found on the admission of the above 
pathology the most rational, and to offer the best hope of success. 
We have reference to that treatment which is addressed almost ex- 
clusively to the nervous system, and has for its object the sustenta- 
tion and elevation of its energies. Some of the means employed 
have been attended in their application with the most marked bene- 
ficial results. Among these, we would mention the plan of Dr. Per- 
cival, wherein the disease was treated by frequent profuse cold 
affusions, especially in the case of children ; which treatment we 
should rationally expect, from the known effect of cold water thus 
applied, to improve the condition of the depressed nervous centres. 
The administration of stimulants, as camphor, quinia, brandy, opium, 
turpentine, and the ethers, have all been favourably known to the 
profession as remarkably efficient in these fevers. 

In relation to the beneficial results recently obtained from large 
doses of quinia, by Dr. Dundas and others, we can readily appre- 
ciate what vast benefit may accrue from them, especially in cases 
where the cerebro-spinal system of nerves are extensively implicated, 
and where the disease is marked by regular obstinate paroxysms, 
for quinia, though it possesses, in our opinion, but little influence 
over the ganglionic system itself, still, would relieve these periodic 
exacerbations by its effects upon this system, through the cerebro- 
spinal nerves (which in these cases we regard as the instigator of the 
paroxysm), upon which most of its power is expended. That the 
doses required should be large, we can easily understand, as any 

* Of course, this term is not applied in its offensive sense. 



GO INQUIRY INTO THE NATURE OF TYPHOIDAL FEVERS. 

effect produced upon the ganglionic system through the cerebro- 
spinal is only accomplished by powerful and long-continued impres- 
sions, on account of the comparative isolation of the two systems 
from each other. 

To those who are in the proper field for such experiments, and 
possessed of the proper facilities, we would recommend the trial, in 
typhoid and typhus fevers, of such agents as are known to possess a 
direct power to stimulate the nervous system, even when in a state 
of partial paralysis — such an agent is strychnia. This we would 
suggest as applicable in minute but efficient doses, with the view 
of waking up and restoring the diminished energy of innervation, 
upon which the impaired function depends, in the same manner that 
we would advise it in other similar cases where the cerebro-spinal 
system was implicated. 

The above is all we offer in regard to treatment ; there are many 
measures of a like nature, which, were we writing a complete treatise 
on the management of these diseases, would require a full and ex- 
tended consideration, as also the measures and applications which 
the emergency of each case will naturally suggest and demand. 

H. F. CAMPBELL, 
C. T. QUINTARD, 
ROBERT CAMPBELL, 

Committee, 



III. 



PRIZE ESSAY. 



THE 



EXCITO-SECRETORY SYSTEM OE NERVES. 



ITS RELATIONS TO 



PHYSIOLOGY AND PATHOLOGY. 



Observation becomes experiment when used in severe processes 
of induction. — Victor Cousin. 



To this Essay the prize of one hundred dollars was awarded at the tenth 
annual meeting of the American Medical Association. 



MAY, 1857. 



PRIZE ESSAY. 



THE EXCITO-SECRETORY SYSTEM OF NERVES. 



The object of the present essay, is to develop more fully a 
function of the nervous system, which, though enunciated and 
described nearly seven years ago in this country, 1 is only now be- 
ginning to be fully recognized by the profession in Europe. 2 We 
refer to that function which has been termed the Excito-secretory* 
and which results from the relation subsisting between the excitor 
or sensitive nerves of the cerebro-spinal and the secretory branches 
of the ganglionic system. It is by virtue of the particular system 
of nerves thus resulting, as we hope to demonstrate in the present 
paper, that a great many of the important acts of nutrition and 
secretion are modified in circumstances both of health and disease, 
and further, that it is to aberrations in this particular function that 
many of the heretofore, mysterious phenomena of diseased action 
are mainly attributable. 

The prosecution of this very interesting inquiry is necessarily 
embarrassed by many difficulties. The generalization of kindred 
facts, long established in other relations, and made the basis of 
induction in those relations, when they are now transferred to an 

1 The Influence of Dentition in producing Disease. By Henry F. Campbell, M.D., 
Demonstrator of Anatomy in the Medical College of Georgia. Medical and Surgi- 
cal Journal, vol. vi. p. 321. June, 1850. 

2 London Lancet, American edition. March, 1857. Excito-Secretory System of 
Nerves. By Marshall Hall, M. D., F.R.S., &c. 

3 Vide Transactions of the American Medical Association, vol. vi., art. Sympa- 
thetic Nerve in Reflex Phenomena. By Henry F. Campbell, of Georgia. May 3d, 
1853. 






64 PRIZE essay: 

entirely new position, and made to serve as data for evolving a new 
result, in many instances opposed to those of their former inter- 
preters, will give to our reasoning a character of novelty, which 
we fear may be stigmatized as innovation by those holding adverse 
opinions to our own. Then, again, the data for our deductions 
being scattered throughout the vast domain of medicine, and often- 
times associated with other facts which are entirely irrelevant, it is 
a matter of no small labor to dissolve these associations, and to 
place them in their proper and pertinent relations for the deduction 
we wish here to accomplish. "We will, notwithstanding, give our- 
selves to the uninviting task, even with these forbidding aspects of 
it frowning upon us, for we are impelled to it by the reflection, that 
the field is a rich one, that the fruit is ripe and ready for harvest, 
that the data accumulating for years need only a proper interpre- 
tation to make them yield the very results we hope to draw from 
them, and further, that did we not perform the present duty, many 
years cannot elapse before some other will give himself success- 
fully to the same important work. 



THE NERYOXJS SYSTEM. 

The Nervous System, as has been long admitted, is divisible into 
two grand portions, the Cerebro-spinal and Ganglionic, or to speak 
physiologically, the nerves of animal life, and the nerves of organic 
life. In the perfect being, endowed with these two systems of 
nerves, a multitude of facts, the result both of observation and ex- 
periment, go far to establish the belief, that though evidently per- 
forming functions in the animal economy of very diverse charac- 
ters, these two portions are yet intimately connected with each other, 
and further, that such connection in function, as well as in physical 
relation, is indispensable to animal unity in those beings who pos- 
sess both these departments of the nervous system. 

As in the following essay we shall be required constantly to 
refer to the actions of these two systems of nerves, it will not be 
improper, in the beginning, to recall briefly a sufficient number of 
the admitted facts in relation to their functions, to establish a clear 
view of their respective parts in the animal economy. Firstly, 
then, it is to the cerebro-spinal system, with its varied endowments 
of sensation, motion, special sensation, and perhaps, even intellec- 



THE EXCITO-SECRETOKY SYSTEM OF NERVES. 65 

tion, 1 that the being owes his aclaptedness for a relation with the 
objects of the external world. ■ Between the various portions of 
this great system, while there exist separations and distinctions of 
the most obvious character, there are also relations mutual and in- 
timate, which are of the first importance to the individual. The 
senses, endowing him with the aesthetic faculty, enable him to 
spread before him on the field of consciousness, all which is passing 
in the world without, while the internal, or intuitive phenomena, 
complete the contents of this same field. 2 Thus, the sensible world 
without, and the world of intellect within, according to some, 3 are 
pictured upon a canvas or blank sheet, and presented to the reason 
and the judgment, as data by which the being may direct and 
shape his conduct under the influence of a supreme principle of 
our organization, the Will. These constitute the voluntary acts of 
animal life. Then, on the other hand, there are certain muscular 
acts, equally amenable to the dictates of the will, which are per- 
formed independently of the cerebral organs apparently, and with- 
out putting in requisition either reason, judgment, or the will, 
under the influence of the, so to speak, vicarious power of reflex 
action. This last set of phenomena constitute a body of facts, 
classed under the general term of excito-motory action, and for the 
full development of which, science is indebted to the genius and 
labors of Doctor Marshall Hall. 4 

The other portion of the nervous system, termed the Ganglionic, 
Sympathetic, or Organic Nervous System, was, for a long time, a 
mystery to physiologists, and therefore became the subject of 
much observation and experiment. The views of Willis, 5 Vieus- 
sens, 6 Lancisius, 7 Winslow, Meckel, 8 Zinn, 9 and Scarpa, 10 having 
finally given place to the more rational suggestions of Bichat 11 and 

1 Herbert Mayo, on the Nervous System. "Mind and Matter," Sir Benjamin 
Brodie. 

2 Consciousness is the accompaniment of all our faculties, and, so to speak, their 

echo Consciousness is nothing else than the rebound of the action of all our 

faculties. — Victor Cousin, History of Modern Philosophy, vol. i. p. 322. 

3 Locke. 

4 Lectures on the Nervous System and its Diseases. London, 1838. 

5 Nervorum Descriptio et usus. Geneva, 1695. 

6 Neurograph Univers, lib. 3 de Nervis, cap. v. 

7 De Ganglia Nervorum. 

8 Memoires de Berlin, 1749. 

9 Ibid., 1753. 

10 Annal. Anatom. de Gangliis. 

11 Anatomie generale. 



QQ PRIZE essay: 

Kiel, 1 this system of nerves "has, since their day, become to be 
studied more in reference to the acts of nutrition and secretion, 
than in any other relation. Bichat named it the nerve of organic 
life, and Kiel, having imbibed the idea from him, attributed to it 
the same function. 

Upon this view, gradually advancing, observation after observa- 
tion has been made, and experiment upon experiment performed, 
until Bichat's and Eeil's theories, in regard to its use, have been in 
most part verified, and, at the present day, there is scarcely any 
portion of the organism about whose function opinion is better 
established, than that the formerly called sympathetic nerve, or 
ganglionic system, is the system presiding over nutrition. Inas- 
much, as it is by secretion, or some act analogous to it, that all the 
processes of nutrition are accomplished, it has gradually gained the 
appropriate name of the Secretory System of nerves. It is of this 
secretory system of nerves, and more particularly in its connection 
with the nerves of Eelation — the cerebro-spinal — that we have to 
treat in the present discussion. 

In the investigation of this very important subject, we shall, to a 
certain extent, present an analysis of those observations and expe- 
riments, accumulated from an early period to the present time, 
which* appear to us to have a particular bearing upon our subject, 
in order that we may deduce from this analysis, if possible, a fuller 
development than has been heretofore done, of the excito-secretory 
system of nerves. 

Experiment, without correct analysis, is ever inadequate and un- 
productive. Adopting for our motto the significant sentiment of 
M. Victor Cousin, that "observation becomes experiment when 
used in severe processes of induction," we claim for our generaliza- 
tion of heretofore unapplied results, an importance equal to that of 
actual experiment itself. We would not, however, appear to de- 
preciate the value of experimental research; so far from this, we 
congratulate ourself upon the valuable body of facts, developed by 
this means during the last and the present century, and which now 
are accessible to every one who will enter the laborious field of in- 
ductive reasoning. In our humble opinion, the facts already accu- 
mulated are abundant, link after link has been fashioned, and 
nothing remains for the physiologist but to weld them together, 

1 Archiv. fur die Physiologie. 



THE EXCITO-SECEETORY SYSTEM OF NERVES. 67 

and to construct them into a chain of evidence by pertinent and 
impartial generalization. 

As will be readily observed, by a reference to all late works on 
the subject, these two systems of nerves, viz., the cerebro-spinal 
and the secretory, are ever found in the most intimate relation with 
each other. While we do not conceive that it is here necessary to 
enter minutely into the anatomy of the two systems, we deem it 
advisable to refer briefly to some of the more important connections 
subsisting between them, in order to illustrate our doctrine of the 
excito-secretory function, resulting directly from a consideration of 
these connections. 



SECRETORY SYSTEM OF NERVES. 

The sympathetic, or secretory system of nerves, consisting of a 
chain of ganglia, extended, it is thought by some, 1 from the anterior 
communicating artery of the brain to the ganglion impar, at the 
lower portion of the spinal column, is found everywhere in intimate 
relation with the vascular system, and particularly with the arteries. 
It is evidently, the nerve of the bloodvessels, and the branches fol- 
low and ramify upon their coats, clinging to and encircling them 
" as the ivy entwines itself around the oak." Wherever there is a 
secretory surface, or a gland, which is only a complex secretory 
surface, 2 wherever the metamorphosis of blood is going on, or the 
elimination of a secretion is being performed, there we find distri- 
buted, in greater or less profusion, the branches of the ganglionic 
system; while in convenient collocation to every secretory appara- 
tus, we find also one or more of the ganglionic centres of this sys- 
tem, apparently designed to superintend and direct, and to supply 
nervous force for the mysterious operation. In direct proportion, 
too, to the activity of the nutrient or secretory process, do we find 
these centres of peculiar energy, allotted to any particular portion 
of the organism, and, wonderful to consider, even do the temporary 
and arbitrary circumstances of an organ seem to control and mea- 
sure the amount of actual nerve- substance which that organ, or s}^s- 
tem of organs, shall, for the time being, have to direct and superin- 
tend its nutrition. The well established and generally admitted 

1 Ribes. 

2 Vide Carpenter's Physiology. Owen's Lects. Compar. Anat., and Grant's Out- 
lines Comp. Anat. 



00 PRIZE ESSAY: 

researches of Dr. Robert Lee, together with the pertinent analogies 
found in the other tissues of the uterine system, as the rapid increase 
in all the tissues of the uterus, have placed this last fact beyond all 
reasonable doubt. Indeed, if we admit that the ganglionic system 
is the vis incita to nutrition, and this we must admit; if we recog- 
nize any relation between the amount of nerve-substance devoted to 
any part, and the energy of nervous action in that part, and this we 
must recognize, there can be no escape from the induction that the 
ganglia discovered by Dr. Lee are necessary to the increased action 
going on in the organs of generation during the period of gestation, 
even though they had never been discovered. Dr. Lee is but the 
pioneer probably in this field of research, and we would here almost 
venture the opinion, that time must develop similar growths in the 
ganglia lying adjacent to morbid epigenetic tissues in every part of 
the organism. 

It would be an improving and not unpleasing exercise to enter 
into an extended review of the history of the various experiments 
by which the fact has been demonstrated, that the ganglionic system 
is truly the secretory system of nerves, but time and the special ob- 
ject of this essay will not admit of such discursive views; we wish 
to evolve, as briefly as possible, the excito-secretory system, and 
will, therefore, consider only those points in its history which are 
available for that special purpose. As early as the year 1732, Pour- 
four du Petit found that the division of the trunk of the sympa- 
thetic nerve, opposite the fourth or fifth cervical vertebra in dogs, 
was very rapidly followed by great disturbance in the circulation 
of the eyeball, producing inflammation, flattening of the cornea, 
retraction of the eyeball, with protrusion of a fold of the conjunc- 
tiva, and a flow of tears, and ultimately ulceration and destruction 
of the entire organ. 

The experiments of Dupuy 1 upon horses, wherein he extirpated 
the superior cervical ganglion, were followed by the same local 
results, with regard to the eye, and also by the singular, general 
effect of 'producing an eruption over the whole cutaneous surface, 
which was succeeded by general emaciation and an cedematous state 
of the limbs. Some of Arneman's experiments on the nerves, 2 con- 
firm the above results, for in them, as reported, we find that the 
effect upon the eye teas to produce an ecchymosed and bloodshotten 

1 Journal de Medecine Chirurgie, &c, Decembre, 1816, tome xxxii. p. 340. 

2 Gottingen, 1787. 



THE EXCTTO-SECRETORY SYSTEM OF NERVES. 69 

appearance. Dr. John Eeid, 1 who also experimented in this field, 
cutting and irritating the sympathetic nerve in the neck, leaves a 
similar record, viz: that the conjunctiva became red and congested 
in a few minutes after the operation. In the experiments reported 
by Molinelli, 2 Cruickshank, 3 Mayer, of Bonn, 4 and Brachet, 5 the 
unvarying effect of ligation or section of the sympathetic in the 
neck, has been to affect, or in some manner modify the circulation 
of the blood in the vessels of the conjunctiva and other parts of 
the eye, while on the other hand, those experiments reported by 
Flourens 5 and others, wherein the cerebrospinal nerves and centres 
have been destroyed, go far to show that the circulation is inde- 
pendent to a great degree of this latter system. 

All of the above relate to experimental physiology, and such 
facts have been accumulating for more than a hundred years ; but 
there is another department which should be ever considered of 
equal value, if not more important, in which facts accumulate and 
are occasionally recorded, which possess the most significant and 
pertinent bearing upon the physiology of the nervous system. It 
is scarcely necessary to say, that we refer to the observation and 
record of pathological phenomena. It has ever appeared to us, that 
one great cause of the slow and uncertain progress of physiological 
science, has rested in the fact, that physiologists have not been 
generally, either bedside or autopsic observers, but mainly experi- 
menters — thus being cut off from the observation and discussion of 
some of the most significant phenomena of the nervous system. 
With diligent and intelligent observation, proper generalization 
and impartial induction, the clinical and autopsical facts would be 
found, often, to supersede the most troublesome and unreliable ex- 
periments, and, in the end, could be made to yield a far richer and 
more abundant treasure of results. Unfortunately, from the causes 
mentioned above, viz : that practitioners of medicine are not often 
critical physiological observers, we find but few of these valuable 
facts on record, from which, to evolve results in our present inves- 
tigation. There are, however, a few, and among this few, some are 

1 Edinburgh Medical and Surgical Journal, August, 1839. 

2 Comment Banoniensi, torn. iii. 1755. 

3 Medical Facts and Observations, Philosoph. Transactions, 1795. 

4 Journal der Cliirurgie, 1827. 

5 Recherches Ex'perimentales sur les Fonctions du Systeme Nerveux Ganglion- 
aire. 

6 Systeme Nerveux, 1849, p. 214. 



70 PRIZE essay: 

of the most significant character. It will be observed, that in most 
of the experiments performed on the ganglionic system, the gan- 
glia in the cervical region have been selected, and this is generally 
stated to be on account of their greater accessibility; the abdominal 
ganglia have been only in a few instances 1 experimented on. and 
these experiments, on account of the important and sensitive parts 
cut through to reach the nervous centre operated on, were followed 
by the most unsatisfactory and unreliable results. 

In the experimental investigation of physiological problems, the 
mode of procedure is first to make the experiment ; for instance, 
uncover a nervous centre, apply an irritant, or make a section of it 
or of its afferent or efferent nerves, and note the effect produced upon 
the parts of their distribution ; in the investigation of these pro- 
blems, by pathological observation, the course is reversed ; a cer- 
tain set of inexplicable phenomena arrest the attention — the effect, 
so to speak, is first noted, and afterwards, the cause is investigated, 
and the connection between cause and observed effect thus traced, 
and the physiological principle satisfactorily evolved. Which, we 
would ask, in these two processes, is better entitled to be called the 
experiment? It is our humble opinion that neither has the advan- 
tage, but that the "observation" under these circumstances, " becomes 
experiment," and is fully as useful in the induction as any artificial 
experiment could possibly be, and that it will yield as much. 

Of the above class, will be found the following pertinent facts 
recorded by various authors, but never dwelt upon and allowed 
that amount of significance in a pathologico-physiological point of 
view which we think they deserve. 

" In a case of diabetes, in which the urinary bladder was very 
much dilated," says Lobstein, 2 "Dr. A. Duncan 3 observed, that the 
sympathetic nerve was three or four times larger than usual, from 
its ingress into the abdomen to its termination in the pelvis." Here 
seems to be a relation between the excessive secretion of the kid- 
ney and the increased size of the secretory nerve, which strongly 
corroborates the attributed function of that nerve. 

Lobstein detected an enlargement of the nerves of the right semi- 
lunar ganglion in an unmarried woman, 25 years of age; she had 
been affected with a chronic miliary eruption previous to her death. 

1 Flourens, op. cit., p. 232. Semilunar ganglion. 

2 Structure and Functions of Sympathetic Nerve. 

3 Reports of the Practice of the Clinical Wards of the Royal Infirmary of Edin- 
burgh, 1807 to 1818. 



THE EXCITO-SECEETOKY SYSTEM OF NERVES. 71 

"It Las been proved," says Lobstein, "by observations undertaken 
for that purpose, that the nerves may not only be increased, in 
thickness, but in number likewise." 1. "I dissected," he continues, 
"a case of hydro-sarcocele in the spermatic cord, in which I detect- 
ed many nervous filaments, though evidently belonging to the 
sanguineous vessels, of which one extended to the vas deferens. I 
convinced myself in each case, with the microscope, that I had not 
mistaken the lymphatic vessels for nervous filaments. In a thyroid 
gland of remarkable size, weighing four pounds, which had been 
converted into innumerable cysts, abounding with limpid gela- 
tinous humor, I discovered a great many nerves. Three nervous 
trunks, which proceeded from the laryngeal nerve and upper cervi- 
cal ganglion, entered the gland on each side in company with the 
superior thyroid arteries. Each arterial branch had an attendant 
nervous filament, not connected immediately with the tunics of the 
vessels, but adhering to them by the aid of cellular membrane. 
But all these nervous branches which were linked together by 
anastomotic filaments, formed a beautiful plexus; they were united 
with the nerves of the opposite side, and thus formed a kind of 
crown around the superior part of the gland. From this crown 
branchlets descended upon the external face of the gland, one of 
which was joined by anastomosis with an ascending filament from 
the recurrent branch of the par vagum. Nevertheless, all these 
thyroideal nerves, which formed a network about the arteries at the 
upper margin of the gland, that excited my admiration, presented 
nothing unusual in their structure or appearance." 

We would here ask, if anything could be more corroborative 
than this pathological observation of Dr. Eobert Lee's dissections 
and observations of the nerves of the gravid uterus, and also of our 
own remark, made a few pages back, that the time will probably 
arrive when for every morbid growth there will be discovered an 
increase in the actual nerve-substance in the adjacent parts of the secre- 
tory system connected ivith such growth. 

"But," continues Lobstein, "the contrary of this phenomenon is 
observed in other instances ; to wit, where the number of nerves is 
greatly diminished. I found a kidney entirely destroyed by sup- 
puration, with the exception of a coriaceo-lardaceous capsule, which 
still existed and was full of pus. The pelvis was distended with 
matter as well as the ureter, the parietes of which were very thick 
and hard. There were also observed some indurated and appa- 
rently scirrhous adeps upon the surface of the same kidney, which 



72 PEIZE essay: 

is frequently found in other organic diseases, and especially in those 
produced by chronic inflammation. The renal plexus was composed 
of only five branches, which were very little connected together, but 
exhibited a ganglion half a line broad. When the kidney with its 
nerves was dried, an oily fluid .was exuded from the nervous 
branches ; but the nerves of the other kidney, which was healthy 
when dried in a similar way, did not exhibit this phenomenon." 

A girl of ten years of age suffered from paralysis of the lower 
extremities for some time, but for three months previous to her 
death, she labored under the most incurable diarrhoea with tormina. 
On making a post-mortem examination, there was found a large 
abscess on the left side, extending from the sixth to the tenth dorsal 
vertebra. On opening this abscess, the trunk of the left sympa- 
thetic nerve was found destroyed entirely from the sixth to the twelfth 
vertebra, and the lumbar portion of the same nerve was in a state 
of inflammation. 1 Dr. Aronsshon, of the Strasburg Hospital, re- 
ports two cases; the first, that of a man, forty-seven years old, 
affected with diarrhoea. He died with a tumor in the abdomen, for 
which he was examined, and it was found that the semilunar ganglia 
were affected with, distinct inflammation. The other case was that of 
a woman, aged about thirty years, who in her second pregnancy 
was subjected to vomiting throughout the whole gestation. She 
was also affected with a furfuraceous eruption vpon the breast and 
arms, with swelling of the limbs and with diarrhoea. On post-mortem 
examination, the semilunar ganglia were found in a state of genuine 
inflammation. 

We have quoted the above records with the view of illustrating 
the varied effects resulting from injury to the ganglionic system 
and its branches. In them we have seen that such injury, either 
produced in experiment or in the progress of diseased action, has 
been invariably to modify the circulation and the secretion of the 
parts to which its branches were distributed; thus, firstly, in the 
various experimental sections by Arneraan, Pourfour du Petit, 
Dupuy, and Eeid, the eye, and the various appendages upon which 
the branches were distributed, became ecchymosed and bloodshotten, 
and the secretion modified, while, in most instances, the organ was 
finally entirely destroyed. Secondly, in the cases reported by 
Lobstein, we find that a case of diabetes was accompanied with an 
extraordinary development (four times their usual size) of the secre- 

1 Op. citat., p. 147. 



THE EXCTTO-SECRETORY SYSTEM OF NERVES. 73 

tory nerves supplying the kidney; that, in another case, injury to 
branches of this system was found to be accompanied with diar- 
rhoea, while, in several, cutaneous eruptions and oedematous states 
of the body were also concomitants of such injuries; whether expe- 
rimentally produced, or from disease in the centres themselves. 

The above facts, together with many others recorded since, and 
which are every day being brought to light by the indefatigable 
labors of experimental physiologists, we think place the function 
of the ganglionic system beyond all doubt ; but there is one other 
series of experiments to which we desire to refer before entering 
into the discussion of the excito-secretory system, because in them, 
although they were not made for this purpose, we think we find 
even a better illustration of the secretory function of the ganglionic 
system than in any of those heretofore adduced. We refer to the 
experiments of M. Magendie to develop the function of the fifth 
pair of nerves. We find these experiments quoted by Dr. Alcock 
in the Cyclopaedia of Anatomy and Physiology,* and as there reported 
and commented upon by Dr. Alcock, we find in them a demonstra- 
tion of the fact, that an author's results and his .records are some- 
times less useful to himself in arriving at the truth than when made 
subservient to that end, in the deductions of another, who may ap- 
proach them without having been committed to any foregone con- 
clusion. 

The present treatise by Dr. Alcock on the anatomy and functions 
of the fifth pair of nerves, we regard as the best and most reliable 
embodiment of the science upon the subject, and while we have 
reason to dissent from some of the author's views in his strictures 
upon M. Magendie's conclusions upon the significance of his experi- 
ments, we cannot commend the paper too highly for the clear and 
accurate views put forth by him, both in regard to the anatomy and 
the physiology of this important part of the nervous system. 

The discussion of the vital properties of the fifth pair of nerves, 
this writer arranges under the four following heads: " 1. Its sensi- 
bility. 2. Its influence upon the faculties of sensation and volition, 
as also upon the ordinary sensibility of the parts to which it is dis- 
tributed; and 3. Its relation to the special senses, and its connection 
with the function of nutrition.' 11 

With the two first divisions of the subject we at present have but 
little to do. It appears that the sensibility of the fifth pair was first 

1 Dr. Robert Bentley Todd. London. 



74 PRIZE essay: 

experimentally and definitely demonstrated by Sir Charles Bell, 
and that he directed attention to this point, first, in a paper pub- 
lished in the Philosophical Transactions for the year 1821. This 
nerve, when exposed in an ass, " gave acute pain." 1 His observa- 
tions were soon succeeded by those of Herbert Mayo, 2 who also 
experimented upon the ass, pinching the cerebral extremity of the 
trunk of the nerve, and producing the same result as in Bell's ex- 
periment. Magendie repeated these experiments, and by his and a 
multitude of similar experiments and observations from that time 
to the present, the physiology of the nerve in its relation to sensi- 
bility, has been fully established. 

In relation to the second head, it is only necessary to note, that 
the restriction of the voluntary motor influence to the non-gan- 
glionic portion of the fifth pair, was first announced by Herbert 
Mayo, and since then the question has been considered as entirely 
settled by most physiologists. 

But it is more particularly in the relation of the fifth nerve to 
the processes of nutrition, that we are at present interested; and it 
is to this portion of Dr. Alcock's last division of the subject that 
we wish now to refer. 

" The last question proposed to be considered with reference to 
the functions of the fifth nerve is in connection with nutrition. 

" The opinion that this nerve controls the nutrition of the parts 
which it supplies, has been advocated by Magendie more particu- 
larly with regard to the eye. It has been already stated that we 
are indebted to this writer for information in regard to results of 
the division of the entire trunk of the nerve, within the cranium. 
Of these, the most prominent is the entire loss of sensibility on the 
same side of the face, and in regard to the eye especially, loss of 
sensibility in the conjunctiva, upon which the most irritating che- 
mical agents, then, produce no impression. These immediate effects 
of the section were followed by others not less remarkable ; on the 
next day, the sound eye was found inflamed by the ammonia which 
had been applied to it, while the other presented no trace of inflam- 
mation. Other changes, however, supervene. The cornea of the eye 
of the side on which the section is made, twenty-four hours after- 
wards begins to become opaque; after seventy-two hours, it is much 
more so, and five or six days after, it is as white as alabaster. On 

1 Cyclopedia of Anatomy and Physiology. 

2 Physiological Commentaries, No. 1, p. 110. 1822. 



THE EXCITO-SECRETORY SYSTEM OF NERVES. 75 

the second day, the conjunctiva becomes red, inflames, and secretes 
a puriform matter. About the second day, the iris also becomes 
red and inflames, and false membranes are formed upon its surface. 
Finally, the cornea ulcerates, the humors of the eye escape, and the globe 
contracts into a small tubercle. In endeavoring to ascertain the cause 
of these changes," continues Dr. Alcock, " Magendie, on the suppo- 
sition that they might be owing either to the continued exposure of 
the eye to the air, or to the want of the lachrymal secretion, divided 
the portio dura in one rabbit, the effect of which is to destroy the 
power of closing the eyelids ; and from others he cut out the lachry- 
mal gland ; but in neither case did opacity of the cornea succeed. 
The sequence of the effects mentioned after the section of the nerve, 
might naturally lead us to infer that the loss of nervous influence 
gives rise to them. But such is not the inference drawn by Magen- 
die, nor indeed can it he admitted/ Absence or subtraction of an 
influence cannot be directly the cause of an alteration in the condi- 
tion of an object otherwise than by allowing it to come or return to 
a state from which it is preserved by the presence of the influence, 
and there is no good reason, either theoretical or experimental, for 
believing that the state induced in the case under consideration is 
one in which the eye would necessarily be — which, in fact, would 
be natural to the organ but for the restraining influence exerted 
through the fifth nerve." And a little further on Dr. Alcock re- 
marks : " But indeed there does not appear any reason for admit- 
ting that the alterations which took place in the condition of the 
eve were produced directly by the loss of nervous influence. Hav- 
ing, as he conceived, disproved, by the experiments related, the 
idea that the alterations were owing to the continued exposure of 
the eye to the air, or to the want of the lachrymal secretion — the 
only other causes which appear to have occurred to him — Magendie 
arrived at a conclusion the opposite of that just mentioned, and 
adopted the opinion that the phenomena ' depend upon an influence 
purely nervous,' 1 exerted by the fifth nerve upon the eye — ' an in- 
fluence independent of the connection of the nerve with the spinal mar- 
ro'x? 2 — an influence proper to the nerve, which has not its source in the 
cerebrospinal system, and which is even the more energetic the further we 
remove from that system to a certain distance, of which the following 
is his proof: 'Alterations of nutrition in the eye are the less com- 

1 Xnatomie des Sjstemes Nerveux, &c, t. xi. p. 716. 

2 Journal de Physiologie, p. 304. 



76 prize essay: 

plete, the less rapid, as ice remove further from the point of hranching 
of the nerves of the fifth pair, and as we cut within the cranium, 
the fasciculus of origin the nearer to its insertion; finally, the sec- 
tion of the nerve on the margin of the fourth ventricle no longer 
produces any alteration in the state of the eye.' 1 On this view, 
there are plainly two positions advanced, viz : that the nerve, does 
itself exert a proper and independent influence upon the nutrition 
of the eye, and that it is the section of the nerve which causes the 
exercise of that influence, or, to use his own words, which is the 
cause of the inflammation, &c. That the occurrence of the altera- 
tions in the eye, in the case in question, is not due to an influence 
exerted by the brain through the nerve, and that it must proceed 
from another cause, and that not dependent upon the connection 
between them, is manifest, since it is consequent upon the inter- 
ruption of that connection; and therefore, if the nerve do possess 
the supposed influence, it must be a proper and independent one; but 
are we therefore to infer that the nerve does exert such an influence 
upon the organ ? It appears to the writer (Alcock) that we cannot ; 
for can we suppose that the nerve is endowed with a property to be 
displayed expressly under circumstances which, it is fair to say, 
were not contemplated in the establishment of natural laws, viz., in 
cases of mutilation? — or, is it possible that a separate influence can 
exist in the nerve, and increase in energy in proportion as the nerve 
is curtailed? for, the nearer the section is made to the eye, the more 
remarkable are the effects. 2 Or if any other proof that the nerve 
does not possess such an influence be wanting, can we suppose that 
it is possessed for the eye and not for the other parts to which the 
branches of the nerve are distributed? Why does not the inflam- 
mation forthwith assail the nostrils, the mouth, and cheeks, upon 
the mere section of the nerve as well as the eye ? 3 Manifestly 
because no such influence exists; and indeed the data upon which it 
has been assumed, instead of proving the position, leave it precisely 
as it was ; for inasmuch as the occurrence of the phenomena upon 
the section proves the existence of the influence of the nerve, in the 
same degree does the absence of the phenomena upon the section of 

1 Op. cit., ibid. 

3 Dr. Alcock appears to think that the ratio ad absurdum is applicab'e here, but 
,we hope to show that Magendie, though not understanding whence the influence is 
derived, is nearer right than he is. 

3 It does, to a certain extent, as shown- by his own quotation from Magendie and 
Dr. Alison. 



THE EXCITO-SECRETORY SYSTEM OF NERVES. 77 

the nerve" (we must here recollect that this second section is further 
back, nearer the medulla oblongata) "disprove it." 

"But was the inflammation caused by the section of the nerve? 
This question, which certainly ought to have been determined 
satisfactorily before a theory nad been founded upon the assump- 
tion, appears to the writer to have been decided too hastily in the 
affirmative. If the section was the cause, no sufficient reason can 
be assigned (?) why it should occasion inflammation in one part to 
which the nerve is distributed, and not in another — yet such is the 
case ; • the eye is the only part in which inflammation supervenes, 
either so uniformly or so quickly as to afford any ground for attri- 
buting the process to the section. In the second place, were the 
section the real and essential cause, it cannot be supposed either on 
the one hand that the non-essential circumstances could influence, 
or at all events, prevent the effect, or on the other that they could 
produce it. Jfow it will presently appear that both the one and 
the other may take place ; and a comparison of Magendie's experi- 
ments and their results will alone suffice to show, that the real 
cause is to be sought elsewhere than in the section of the nerve. 
Magendie divided the nerve in three different situations; first, 
through the temporal fossa ; secondly, within the cranium, between 
the Gasserian ganglion and the pons Varolii; and thirdly, at the 
margin of the fourth ventricle; and his own general account of the 
results, w r hich has been already cited, is as follows : ' Those altera- 
tions in the nutrition of the eye are the less complete, the less rapid, 
as we recede more from the point of branching of the nerves of the fifth 
pair ; and as we cut within the cranium, the fasciculus of origin the 
nearer to its insertion; finally, the section on the margin of "the 
fourth ventricle no longer produces any alteration.' It is plain 
then that the nerve may be cut, and the changes in the eye ensue 
or not, according to circumstances to be yet explained. On the 
other hand, that effects similar in kind, if not equal in degree, may 
be produced by circumstances not essential to their production — 
according to the doctrine maintained, but incidentally associated 
with the supposed cause — that such effects may be produced by 
such circumstances when dissociated from the other and operating 
separately, the author (Alcock) feels justified in asserting from the 
result of some experiments lately made by himself, which lead to 
the conclusion that similar effects may be produced without the 
section of the nerve at all, and that an injury in the vicinity of the 
7 



78 PRIZE essay: 

orbit may excite them, though neither the trunk of the fifth itself, 
nor its ophthalmic division, has been divided. In endeavoring to 
determine the nerves of taste, he undertook the removal of the 
ganglion of Meckel from the dog. In order to accomplish this, it was 
necessary to displace the zygoma antl the coronoid process of the 
jaw; he attempted it several times before he succeeded, and failed 
at different stages of the operation ; but in almost every instance 
the eye of the same side became bleared within the next two days. The 
animal kept it nearly closed, a whitish puriform matter was dis- 
charged from it, in quantity proportioned to the case, which con- 
creted between the lids, and the animal made no attempt to remove 
the matter or cleanse the eye; the affection of the eye was always 
proportioned to the violence done, and abated with the inflamma- 
tion of the wound, and in one of the instances in which the ganglion 
was removed, it actually produced opacity of the cornea, and ulceration 
in that structure, which continued after the lapse of m more than a 
month from the operation ; yet most assuredly neither infra-orbital 
nor ophthalmic nerves had been divided. Thus if, on the one hand, 
the nerve" (meaning the fifth) "may be cut and the changes not 
ensue, on the other, it may be left uncut, and yet the changes may 

occur From the preceding considerations it appears to the 

author necessary to infer, that the changes which supervene in the 
eye after the section of the fifth nerve in certain cases, take place 
independently of the section as the primary, immediate, or proper 
cause ; for were it otherwise, it cannot be supposed either that the 
difference of half an inch to one side or the other, as regards the 
point of section, could so influence the cause as to prevent or 
allow these changes, or that they could occur, even in degree, with- 
out it. 

" How, then," continues our author, " are the phenomena to be 
explained ? It has been said by Magendie that they are less 
marked the more we recede from the point of branching of the 
nerve ; but it is to be further observed, that as we recede from the 
point of branching of the nerve, we recede also from the orbit, 
the eye, and its appendages, and in our operation for the division 
of the nerve, we do less violence either in their vicinity or actually 
to them, until the operation is performed at such a distance from 
those parts that they are not involved in the injury inflicted 

" It would seem, then, that the great violence inflicted either in 
the vicinity of the eye, or actually to its appendages, constitutes the 



THE EXCITO-SECRETORY SYSTEM OF NERVES. <9 

primary and immediate cause of the alterations which took place in 
the eye in the experiments under consideration." 1 

We have quoted thus extensively from Dr. Alcock's paper, not 
merely because we think we see the interpretation of the phenomena 
which neither himself nor Magendie seems to have suspected, but 
more particularly because his account of these experiments, and 
also his reasoning upon them, appear to our mind to embody all 
the phenomena necessary to develop very fully the secretory func- 
tion of the ganglionic system of nerves, and also to illustrate the 
connections between that system, as it exists in the eye and its ap- 
pendages, and the cerebro-spinal system, in a most pertinent and 
striking manner. The very difficulties which he proposes, and the 
mystery with which he and Magendie both seem to invest the phe- 
nomena — the one attributing an inherent, independent power to the 
fifth pair, while the other denies its existence, only serve to bring 
the question under consideration more fully into a form of proposi- 
tion approaching to that which logicians technically term the 
dilemma, and render it more apt for a ready and satisfactory 
solution. 

Let us review, briefly, a few of the results of these experiments on 
the fifth nerve, and also some of the deductions of Magendie, with 
those of Dr. Alcock, in regard to them. With the results relating 
to the sensibility or motor power in the parts, we have nothing to 
do, but in those results which concern the alteration in the tissues 
of the organs to which the branches of the fifth are distributed, we 
fcre deeply interested. 

It will be observed, then, that besides the loss of sensation, &c, 
" other changes supervene. The cornea of the eye of the side on 
which the section is made, twenty-four hours afterwards, begins to 
become opaque ; after seventy-two hours, it is much more so, and 
in five or six days, it is as white as alabaster. On the second day, 
the conjunctiva becomes red, inflames and secretes a puriform mat- 
ter. . . . Finally, the cornea ulcerates, and the humors of the eye 
escape, and the globe contracts into a small tubercle." 

Mons. Magendie, in reasoning upon these phenomena, is careful 
to state, that these effects are not due to the arrest of the lachrymal 
secretion, which also is one of the common results of the section, or to the 
continued exposure of the eye to the air, and he further confirms 

' Cyc'opedia of Anatomy and Physiology, by R. B. Todd, M. D. ; article, Fiftr 
Pair of Nerves, p. 312; B. Alcock, contributor. 



80 • PKIZE essay: 

the justice of his opinion by two independent experiments — first, 
the removal of the gland without these results, and secondly, a 
section of the seventh pair. He thus, apparently, fairly comes to 
the conclusion, that the section made upon the trunk and branches 
of the fifth pair is the cause of the changes in the tissues, and in 
the secretions of the eyeball; and becomes settled in the convic- 
tion, that in this nerve resides the controlling influence of the cir- 
culation of this organ. But upon making his sections further 
back, that is, nearer to the or%in of the nerve at the fourth ven- 
tricle, although more of the nerve is cut off, or " curtailed," still 
the amount of the effect is diminished ; he therefore comes to the 
conclusion, that this power, which, to his mind, undoubtedly exists 
in the fifth nerve, must be independent of the spinal marrow and 
the brain, that it must be an "inherent power" in the fifth nerve 
itself. His reviewer, Dr. Alcock, denies this theory, and accounts 
for the diminution in the results on receding from the eye, on the 
theory that as he receded from the eye, just so much was the me- 
chanical local injury removed from the vicinity of that delicate 
organ, and hence the result would not be expected to be so marked. 
The explanation of these apparently mysterious results, and the 
conciliation of these very opposite opinions, we think are to be 
found in a more extended view of the subject, and in a comparison 
of the results of Magendie's experiments with the known results 
of certain other experiments made years previous, not with any 
view, however, to develop the functions of the fifth pair of nerves. 
From the mere fact that they have been brought within a few* 
pages' proximity to each other, the reader has doubtless been struck, 
ere this, with the remarkable similarity — indeed, identity — of the 
results subsisting between this series of experiments by Magendie, 
to determine the function of the fifth pair of cerebro-spinal nerves, 
and those performed nearly one hundred years before by Pourfour 
du Petit, 1 on the. dog, to determine the function of the branches of 
the sympathetic nerve, again by Arneman, 2 and later by Dupuy, 3 
upon the horse, and still later by Dr. John Eeid, 4 on the dog, the 
cat, and the rabbit; all followed by the same uniform results, viz., 
congestion of the eye, opacity of the cornea, aberration in secretion, 
purulent discharge, ulceration, discharge of the contents of the 
globe, and generally, final destruction of the entire organ. Could 

1 Loc. cit., 1732. z Loc. cit., 1789. 

3 Loc. cit., 1816. 4 Loc. cit., 1839. 



THE EXCITO-SECRETORY SYSTEM OF NERVES. 81 

we ask a closer identity of results? "When we scan Dr. Alcock's 
arguments against Magendie's theory a little closer, and analyze his 
own experiments, which he adduces to prove that Magendie lias 
caused his results by the " mechanical violence inflicted" we find a 
still stronger corroboration of the opinion that all the results of 
Magendie's experiments which relate to nutrition and secretion, 
were of the same character and from the same source as those pro- 
duced in the older series by Pourfour du Petit, Arneman, Dupuy, 
Eeid, Molinelli, and others. "The author" (referring to himself) 
" feels justified in asserting, &c, from the result of some experiments 
lately made by himself, which lead to the conclusion that similar 
effects may be produced without the section of the nerve (fifth pair) 
at all, and that an injury in the vicinity of the orbit may excite 
them, though neither the trunk of the fifth itself, nor its ophthalmic 
division, has been divided. In endeavoring to determine the 
nerves of taste, he undertook to remove the ganglion of Meckel from the 
dog." He failed in some of these operations, and in others succeed- 
ed, "and in almost every instance, the eye of the same side became bleared 
within the next two days." A whitish puriform matter was discharged 
from the eye; "and in one of the instances in which the ganglion was 
removed, it actually produced opacity of the cornea and ulceration in 
that structure. . . . Yet, most assuredly, neither the infra-orbital nor 
ophthalmic nerves had been divided." In this last remark, we see 
plainly whence these changes can arise ; this Meckel's ganglion, so 
incidentally and apparently unsuspectingly mentioned, is a ganglion 
of the sympathetic or secretory system of nerves — a centre of that 
controlling influence which we have seen presides over, directs, and 
superintends the nutrition and secretion in every vascular organ of 
the body — a centre, similar in its endowments and inherent pecu- 
liarities to the cervical ganglion experimented on by Pourfour du 
Petit, nearly a century before, with identical results. If there ever 
is any doubt remaining in relation to the ganglionic character of 
this spheno-palatine body (some have said it was only a mass of 
fat), that doubt must be at rest forever, for while Dr. Alcock's ex- 
periment has failed to controvert the statement of Magendie, that 
the fifth nerve possessed some inherent element for controlling the 
nutrition of the parts to which it is distributed, and rather estab- 
lishes the reverse, it proves most satisfactorily that Meckel's gan- 
glion is, indeed, a ganglion of the secretory system of nerves. It 
further proves that its branches, though not apparently distributed 
directly to the eye, are very important to the processes of nutrition 



82 PKIZE essay: 

going on in that organ. But, it may be asked, if these aberrations 
of nutrition and secretion following the section of the fifth nerve at 
certain points, did not accrue from the mechanical violence done to 
the parts ; if, as it appears, the escape from these results tlid not 
come from a connection being maintained with the medulla spinalis, 
how can the phenomena be explained without the admission of the 
theory advanced by Magendie, viz., that " a separate influence may 
exist in the fifth nerve, increasing in energy in proportion as the 
nerve is curtailed?" This brings us naturally to an important por- 
tion of our subject, viz., the consideration of the relations and con- 
nections subsisting between the trifacial of the cerebro-spinal and 
the ganglionic or secretory system of nerves, for it is in this region 
that we expect to illustrate more particularly some of the more 
striking features of that somewhat recently described function which 
results from these connections and relations — the excito-secretory. 

That the fifth pair of nerves should be endowed with "a separate 
influence, increasing in energy in proportion as the nerve is cur- 
tailed," would, indeed, appear to any one, as it does to Dr. Alcock, 
a preposterous and paradoxical proposition, unworthy of any at- 
tempt at serious refutation; and, hence, he gives to it a simple but 
decided denial, and seeks the explanation of the phenomena else- 
where, viz., in the violence done to the parts concerned in the per- 
formance of the experiments. But to our mind, keeping constantly 
in view the whole train of phenomena here presented, and still 
giving due weight to the significance of the results of other experi- 
ments, performed years before to determine the function of a totally 
different portion of the nervous system (the sympathetic or secre- 
tory), the theory of Magendie is perfectly acceptable when he refers 
to " an influence residing in the nerve, and that it increases as the 
nerve is curtailed." The proposition is only preposterous when we 
fail to apply the key to their explanation, which key is impartial 
and unbiased observation and generalization. 

The fifth pair, trifacial, or trigeminal nerves, is a pair of nerves 
of the cerebro-spinal system, arising, according to the most reliable 
authorities, from the medulla oblongata, near the region of the 
fourth ventricle. In its distribution, it is found displayed princi- 
pally upon parts endowed with sensation, as the cutaneous sur- 
faces of the face, side of the head, the eye, &c. &c, but in addition 
to these parts, we find that branches are sent to the tongue, lach- 
rymal gland, mucous membrane of the nose, &c. And, also, that a 
portion of this trifacial nerve supplies branches to certain muscles 



THE EXCITO-SECRETORY SYSTEM OF NERVES. 83 

of the jaw, viz: the pterygoid, buccinator, masseter, and tem- 
poral. With these muscular or motor branches, we are not con- 
cerned in the present investigation, nor, indeed, with the many 
theories promulged by authors attributing various endowments of 
special sensation, as of hearing, olfaction, 1 vision, 2 &c, to the sensi- 
tive portion of the nerve, our interest being principally in its 
endowment of ordinary sensation, and the alleged control which it 
exerts over the nutrition of the parts to which it is distributed. In 
considering more closely the three divisions of the fifth pair of 
nerves, we find that the upper division, or ophthalmic nerve is given 
off from the superior part of the Gasserian ganglion, and as a short 
trunk proceeds towards the orbit, where it divides into three 
branches ; the frontal, the lachrymal, and the nasal. The frontal 
branch goes to the cutaneous surfaces about the forehead and eye- 
lid, &c., and by experiment and observation, is found to endow 
these parts with ordinary sensation; but the two remaining 
branches, viz: the lachrymal and the nasal, are principally distri- 
buted upon parts and surfaces, which, while they possess the com- 
mon attribute of ordinary sensation, yet also perform acts calling 
for endowments not to be supplied from the resources of the cere- 
brospinal system at all — endowments which are only found to be 
conveyed to any part by the distribution of ganglionic filaments in 
that part — we refer to the lachrymal gland, the conjunctiva and 
mucous membrane of the nose, all secretory surfaces, 3 to which 
these two latter branches of the ophthalmic are distributed. The 
secretory element, then, being necessary in the parts to which 
these branches are sent, in order that they may perform their pro- 
per function of secretion, we find placed in convenient juxtaposi- 
tion with them a ganglionic centre of the secretory system, viz : 
the lenticular, or ciliary ganglion, which sends what is called its 
long root, to the nasal nerve, and thus supplies i^with the secretory 
element. The lachrymal branch receives its secretory filaments 
from the carotid plexus through the several branches sent to the 
ophthalmic nerve previous to its division. 4 

The above arrangement we see carried out with regard to the 

1 Scarpa. De Auditu et Olfactu. 

2 Zinn. De differentia fabric® oculi humani et brutorum. 

3 A gland is but a complex secretory surface. See Grant's Outlines of Compa- 
rative Anatomy, Owen's Lectures on Comparative Anatomy, and Carpenter's Com- 
parative Physiology. 

4 Anatomist's Vade Mecum. Erasmus Wilson, p. 485. 



84 PRIZE essay: 

other divisions of the trifacial nerve ; thus, in the case of the supe- 
rior maxillary, inasmuch as certain filaments from this division are 
to be distributed to secretory surfaces, as the buccal mucous mem- 
brane, the mucous membrane of the antrum, the mucous mem- 
brane of the floor of the nares and the palate, 1 we find that ere it 
proceeds to these parts, and even before giving off any of these 
filaments of distribution, it has incorporated with it, two very stout 
trunks from the ganglion previously mentioned, viz: Meckel's 
ganglion, or the spheno-palatine ganglion, and that afterwards the 
naso-palatine, or Cloquet's ganglion, affords it another supply for 
the secretory exigencies of the anterior portion of the mouth and 
lips. Then, again, when we come to consider the last great division 
of the trifacial, viz: the inferior maxillary nerve, we find, to a cer- 
tain extent, the same character of distribution, consequently the 
same need for the secretory element, and just as certainly, the 
same collocation of a ganglionic centre, and the abundant supply 
therefrom of the required secretory influence. 

"We refer now particularly to its sensitive or internal trunk. 
This we find dividing into three branches, the gustatory, the infe- 
rior dental, and the anterior auricular, which are distributed to the 
teeth of the lower jaw and other sensitive parts, but also to several 
parts which are not only sensitive, but secretory as well; thus we 
find these various branches supply the tonsils, the mucous mem- 
brane of the fauces, the submaxillary gland and duct of Wharton, 
and the sublingual gland, while certain branches go to the meatus 
auditorius and the tympanum. Here the submaxillary ganglion 
serves as the magazine of supply, and that is reinforced probably 
by the considerable tributary filament, the chorda tympani, which 
runs along in the sheath of the gustatory, to join that ganglion at 
the submaxillary gland. The auricular nerve which supplies, in 
part, the mucous secretory surface of the internal meatus and the 
tympanum, is fitted for the secretory office by the branches it re- 

i "Previously to their distribution, the dental nerves form a, plexus" (this looks 
very much like they contained ganglionic filaments, the peculiar trait of which is 
to form plexuses), "the superior maxillary plexus, in the outer wall of the superior 
maxillary hone immediately above the alveolus. From this plexus, the filaments 
are given off which supply the pulps of the teeth, the gums, the mucous membrane 
of the floor of the nares, and the palate. Some gangliforrn masses have been de- 
scribed in connection with the plexus, one being over the canine, and another over 
the second molar tooth." — Anatomist's Vade Mecum. Erasmus Wilson, p. 442. 



THE EXCITO-SECRETORY SYSTEM OF NERVES. 85 

ceives 1 from the otic ganglion situated near the inner surface of the 
inferior maxillary nerve, immediately below the foramen ovale. 
The last, but at the same time the most important region in this 
connection, which we will refer to before attempting to explain the 
results of tylons. Magendie's experiments, is the interior of the globe 
of the eye itself. This portion of the being is, to all intents and 
purposes, an organism of itself, cut off and excluded from all chan- 
nels of communication with the nervous centres, except those which 
enter its interior by the nerves which perforate the sclerotic coat. 
Yet its endowments are varied and complex; general sensation, 
special sensation, and muscular motion, with an exquisitely adjusted 
excito-motory correlation, as evinced by the contractions and dila- 
tations of the pupil. In order to maintain these several functions, 
there are sent to this organism nerves severally endowed with each 
of the above functions. Thus for the special sense, of which it is 
the organ, we find the optic nerve; for ordinary sensation and for 
motion, and its excito-motory phenomena, branches of the fifth pair, 
and also branches of the third pair proceed towards its posterior 
wall, and finally enter it, conveying to the organ all those powers, 
both primary and subsidiary, necessary for the exercise of its pecu- 
liar function, vision. But the eye, besides being a delicately ar- 
ranged apparatus of vision, is also a portion of a living organism — 
to a certain extent, as we have before said, a separate living 
organism itself, and besides aesthetic and motory endowments, it 
further requires to be maintained as a nutrient and secretory organ ; 
its circulation, its metamorphosis of blood and tissues have all to be 
superintended and directed; the optic nerve, nor the fifth, nor yet 
again can the third pair answer the requirements of these peculiar 
processes. The secretory element is indispensable, and can only be 
supplied by the ganglionic or secretory system ; without this ele- 
ment in its nervous organization, the eye would not be at any one 
moment in the status or condition in which it was the moment be- 
fore. Its circulation would be paralyzed, its secretion and absorp- 
tion would be null, stasis would be the result, the beautiful trans- 
parency of the cornea would be replaced by opacity, and ulceration, 
disintegration, and finally destruction of Jhe entire organ most cer- 
tainly ensue. 2 

1 " The branches of communication are two or three filaments to the outer por- 
tion of the inferior maxillary nerve ; one or two filaments to the auricular nerve, 
&c." — Erasmus Wilson, op. cit., p 484. 

2 See results of experiments before cited. 



86 prize essay: 

How, then, is this ganglionic influence conveyed to the interior 
of the eyeball, and whence does it come ? It probably enters along 
with the filaments of the fifth and the third nerve, and possibly also 
with the coats of the bloodvessels, but mainly with the nerves 
mentioned. It has two principal sources, viz : firstly, tjie carotid 
plexus, or the first cervical ganglion, and secondly, the ciliary 
ganglion. 

As we have seen, the ophthalmic division of the fifth nerve, 
before entering the orbit, and while yet in the outer wall of the 
cavernous sinus, and " previously to its division, receives several 
filaments from the carotid plexus." 1 This plexus is formed, in 
great part, by branches derived from the superior cervical ganglion, 
and consequently when this ganglion is destroyed, 2 the eye becomes 
bloodshotten, and its circulation is modified. The branches of the 
fifth pair, which are intended to supply ordinary sensibility to the 
eye, separate from the rest of the nerve after it has received the 
filaments from the carotid plexus, and proceed towards the back 
part of the ball ; the third pair (motor) having also received " one 
or two filaments from the cavernous plexus," 3 enters the orbit and 
soon gives off a branch for the supply of the interior of the eyeball, 
which branch, like the sensitive filament from the ophthalmic, ap- 
proaches the ball of the eye. Here these filaments destined for the 
ball enter the lenticular ganglion, and obtain a reinforcement of 
secretory filaments, and thus fully provided with the three kinds of 
influence necessary, they enter the globe of the eye to supply its 
delicate tissues, and preside over its various processes of sensation, 
motion, and nutrition. 

In order to present more definitely the various ganglionic and 
cerebro-spinal connections so repeatedly discussed in the above 
paragraphs, we here transfer from a recent edition of Wilson 1 s Dis- 
sector 4 the following illustration and references. 

We are now prepared to examine the paradoxical assertion of 
Magendie, "that a separate influence resides in the fifth nerve, in- 
creasing in energy in proportion as the nerve is curtailed," or in 
other words, the more of the fifth nerve cut off from its connection 

. 

1 Erasmus Wilson, op. citat., p. 439. London, 1844. 

2 As in experiments by Dupuy, Reid, and others, cited. 

3 Erasmus Wilson, op. citat., p. 433. London, 1844. 

4 Edited by William Hunt, M. D., Demonstrator of Anatomy in tlie University 
of Pennsylvania. Published by Blanchard & Lea. Philadelphia, 1856. Page 184, 
fig. 54. 



THE EXCITO-SECRETORY SYSTEM OF NERVES. 



87 



with the brain and spinal centre, the less was the effect upon the 
circulation and nutrition of the eye ; and when he made the section 



Fig. 1. 




The Cranial Ganglia op the Sympathetic Nerve. — 1. The ganglion of Kibes. 2. The filament 
by -which it communicates with the carotid plexus (3). 4. The ciliary or lenticular ganglion, giving 
off ciliary branches for the supply of the globe of the eye. 5. Part of the inferior division of the 
third nerve, receiving a short thick branch from the ganglion. 6. Part of the nasal nerve, receiving 
a longer branch from the ganglion. 7. A slender filament sent directly backwards from the gan- 
glion to the sympathetic branches in the cavernous sinus. 8. Part of the sixth nerve in the 
cavernous sinus, receiving two branches from the carotid plexus. 9. Meckel's ganglion (spheno- 
palatine). 10. Its ascending branches, communicating with the superior maxillary nerve. 11. Its 
descending branches, the posterior palatine. 12. Its anterior branches, spheno-palatine or nasal. 
13. The naso-palatine branch, one of the nasal branches. * The point where Cloquet imagined the 
naso-palatine ganglion to be situated. 14. The posterior branch of the ganglion, the Vidian nerve. 
15. Its carotid branch, communicating with the carotid plexus. 16. Its petrosal branch, joining the 
angular bend of the facial nerve. 17. The facial nerve. IS. The chorda tympani nerve, which de- 
scends to join the gustatory nerve. 19. The gustatory nerve. 20. The submaxillary ganglion, 
receiving the chorda tympani nerve from the gustatory. 21. The superior cervical ganglion of the 
sympathetic. 



as far back as the border of the fourth ventricle, thus cutting off 
the whole of the nerve, no perceptible effect on these processes fol- 
lowed, while all the parts to which the fifth nerve was distributed 
became paralyzed in both sensation and muscular motion. Dr. Al- 
cock denies the existence of the influence above referred to. Of 
the two opinions, we decidedly adopt that expressed by Magendie. 
There is indeed an influence acting in the various sections of the 
nerve exactly in the manner which Magendie describes — an in- 
fluence which Magendie attributed to " some inherent power in the 
nerve itself, independent of the brain or spinal marrow,*' but 
which we, with all due respect to the opinions of that great man, 
the father of experimental physiology, and deference to the reason- 
ing of his distinguished reviewer, still feel compelled to assert, is 



88 



PRIZE ESSAY: 



conveyed to certain branches of the fifth pair by virtue of their 
connections with the ganglionic or secretory system of nerves. 

For the more ready apprehension of the subject, we place before 
the reader another one of the illustrations, with references, taken 
from the work above cited. 1 



Fig. 2. 




The Branches of the Fifth Nerve. — 1. The Gasserian ganglion. 2. The ophthalmic nerve. 
3. The frontal nerve. 4. Its supra-trochlear branch. 5. The lachrymal nerve. 6. The nasal nerVe. 
7. Its branch of communication -with the ciliary ganglion. 8. The passage of the nerve through the 
anterior ethmoidal foramen. 9. The infra-trochlear nerve. 10. The superior maxillary nerve. 
11. Its orbital branch. 12. The branches of communication with Meckel's ganglion. 13. The pos- 
terior dental branches. 14. Middle dental branches. 15. The anterior dental branches. 16. The 
infra-orbital branches. 17. The inferior maxillary nerve. 18. Its external or muscular division. 
19. The internal division of the inferior maxillary nerve. The arrow marks the separation of these 
two divisions of the nerve by the external pterygoid muscle. 20. The gustatory nerve. 21. The 
branch of communication with the submaxillary ganglion. 22. The inferior dental nerve, arising 
by two roots. 23. Its mylo-hyoidean branch. 24. The auricular nerve. 25. Its branch of commu- 
nication with the facial nerve. 

As will be perceived, the above lignograph is a representation 
of the distribution of the branches of the fifth pair to the eye, the 
upper and lower jaw, with the teeth of each, and to the tongue, &c. 
&c, though the organs themselves are not here represented. 

Now, Magendie found " that the alterations in the nutrition of 
the eye were less complete and less rapid as he receded from the 
point of branching of the fifth nerve;" and as he cut upon the 
ocular side, of the point of branching, he found these changes to 
increase. Our •explanation is the following : "When the section 
was made anywhere between the point of junction of secretory fila- 



1 Wilson's Dissector, p. 177. Fig. 52. 



THE EXCITO-SECRETORY SYSTEM OF NERVES. 89 

merits with the nerves supplying the eye, then the nutrient func- 
tion became disturbed, because the secretory influence passing 
from the ganglionic centre was interrupted, but as he receded with 
his sections towards the spinal origin of the fifth pair, he more and 
more avoided producing this interruption — that is, more of these 
ganglionic filaments were allowed to escape intact, and more of the 
secretory influence was allowed to be conveyed, until, making his 
section at the border of the fourth ventricle, they all escaped inter- 
ruption, and the entire amount of the ganglionic influence was trans- 
mitted to the parts, while all the sensory and motory influences were 
cut off. 1 

There are many arguments which could be brought to sustain 
this view of the question, but we regard them as unnecessary. It 
is truly surprising that Magendie did not see the relation which the 
results of his own experiments bore to the results of those per- 
formed about ninety years (1732) previously by Pourfour du Petit, 
and still later by others, and the more especially as his own idea of 
an "inherent, independent influence of the nerve" groped so near 
to the truth, and was so very suggestive of it. It is even more 
surprising that his philosophic reviewer, Dr. Alcock, should have 
mistaken the true explanation, and was almost led to impeach the 
skill of the great experimental physiologist; but the one, intent 
upon the determination of the function of a special nerve, could noi 
open his mind to general views and the records of physiology, 
while the other, intent upon refuting the assertions of his author, 
confined himself, too, to the special set of experiments under con- 
sideration, and failed to see what generalization would have made 
clear.- Truly this was experiment proceeding blindly without her 
guide and mentor, observation. 

"We think that we may now venture to say that, besides the 
results afforded by the oft referred to experiments of Petit, Dupuy, 
Arneman, Brachet, and Eeid, we can legitimately base our reason- 
ing upon those also of Magendie, and that by this transfer of his 
results to their proper place, the data for our induction with regard 
to the phenomena of the secretory system have been somewhat 
increased. Observation here, then, has become experiment, for it 
will be admitted that observation has here converted a whole series 

1 Since completing the above rather prolonged examination of Magendie's experi- 
ments, we are gratified to find that M. Waller, of Bonn, has expressed a similar 
view of the same results. 



90 PEIZE ESSAY: 

of experiments, made by Magendie to determine the functions of 
the cerebro-spinal fifth pair, into a most valuable series, illustrating 
a totally different system, viz., the ganglionic or secretory system 
of nerves. What has been demonstrated in regard to the eye a 
little consideration will show is a principle pertaining to the dis- 
tribution of the secretory nerves in all parts of the organism. In 
the eye, the main intents and purposes of whose organization is to 
subserve the function of vision, nutrition is only an auxiliary pro- 
cess, and consequently we find the secretory filaments and their 
function engrafted upon the senso-motory nerves supplying that 
organ ; but there are certain other organs in which the primary 
object and end is nutrition and secretion ; this is the case with the 
intestinal canal ; it is the source of nutrition for the whole animal 
frame, and here we find the secretory system predominating, while 
the senso-motory, except in certain portions, is almost ignored and 
excluded. In the kidney, again, we find an organ entirely devoted 
to secretion, and entirely under the immediate superintendence of 
the ganglionic system. In close relation with both these appa- 
ratuses of nutrition and secretion, do we find a number of power- 
ful ganglia, which send large and multitudinous filaments into the 
tissues of these organs. On the other hand, in the skin, we have, 
so to speak, an organ, one of whose main intents is to serve as a 
tactile and excitor surface to the entire organism ; consequently, we 
find here the sensory nerves most abundant, and sensibility attain- 
ing its highest development — its culmination : but this cutaneous 
surface, besides being the tactile and excitor organ of the body, is 
also a secretory organ, a vast, complicated, and extended gland, the 
eliminations from which are highly important to the well being of 
the individual ; consequently, do we also find, placed in convenient 
juxtaposition to the roots of all its nerves, and in connection with 
them, secretory ganglia, in order to supply the needed element for 
carrying on this process of secretion. We refer to the vertebral 
sympathetic ganglia, which doubtless are intended to supply the 
secretory function to the cutaneous surface ; how this is done, we 
are aware, has not as yet been clearly and fully explained, whether 
by engraftment of filaments upon the sensory nerves, as shown to 
be the case in the nerves of the eye, or by admixture with the 
middle coats of the arteries (the most current opinion), but the fact 
is conceded that such an element is necessary to the circulation of 
parts everywhere, and these ganglia are the most probable sources 
from which that element is supplied. With the examination of the 



THE EXCITO-SECRETORY SYSTEM OF NERVES. 91 

above pertinent facts, we terminate our discussion of the secretory 
system of nerves; others, having perhaps a more direct bearing 
upon our main question, will be adduced hereafter to the further 
development and description of the excito-secretory system. 



THE EXCITO-SECRETORY FUNCTION OE THE NERVOUS 

SYSTEM. 

In- the foregoing examination, we have endeavored to present 
certain allied facts pertaining to the functions of the two grand 
divisions of the nervous system, the cerebro-spinal and the secre- 
tory, in such a manner as we have deemed best calculated to favor 
the admission of the'deductions contained in the succeeding portion 
of this essay. We have seen that to the ganglionic system, and to 
this system alone, are confided all those important and mysterious 
processes which pertain to nutrition and secretion, or, in the words 
of Bichat, "those thousand secret operations of a living body." 1 
It presides over all our internal chemico-vital actions, super- 
intending and directing all blood-changing processes, and instigat- 
ing all metamorphoses occurring in the intimate structure of the 
aninial tissues. It is the system for the internal and individual 
wants of the organism, and its possession enables the being to 
sustain an independent and individual existence, carrying on, to a 
certain extent, all strictly organic actions, without the aid of 
external influences. In corroboration of this view of the subject, 
we here insert a synopsis of the views of Dr. Davey, copied in the 
American Journal of Medical Sciences from the London Lancet of 
June 25, 1853. 

"Dr. Davey read a paper on this subject before the Medical 
Society of London, the principal object of which was to prove the 
independency of the organic nervous system, and, what is more, 
the dependency of the integrity of the cerebro-spinal system in 
common with all the organism, on it. To prove his position, Dr. 
Davey brought forward a variety of facts, more or less startling, 
and these, selected with much apparent care, seemed to tell much 
in favor of the physiological views insisted on. After some preli- 
minary remarks, intended to show the unsatisfactory and contra- 
dictory opinions expressed by our most popular writers on medicine 

1 Op. citat. 



92 PEIZE essay: 

(physiology J, viz., Wagner, Todd and Bowman, Carpenter, and 
others, concerning the ganglionic nervous system, he affirmed, on 
the authority of many good names, that the ganglia of the sympa- 
thetic nerve are those parts first formed in the foetus, and that this 
same fact obtains equally, it was premised, through the whole king- 
dom. The early organism of birds was referred to in confirmation 
of that opinion, which assigns to the solar ganglion and its depend- 
encies an existence anterior to any other part of the animal fabric. 
Especial reference was made to the two monstrosities recorded by 
Mr. Lawrence and Dr. Marshall Hall. The first of these, it is 
known, was born without a brain, but with the spinal cord com- 
plete; but the second, still more wonderful, was born without 
either a brain or a spinal cord. Dr. Davey argued that if, in the 
latter instance, the functions of secretion, absorption, &c, were 
duly and efficiently executed or performed without any aid from a 
cerebro-spinal system, then was this latter in no instance either 
requisite or necessary in any way to the integrity of such functions 
in the animal economy. The ganglionic nervous system, said he, ' 
is perfect at birth, and its functions are also perfect; this is com- 
pletely organized, whilst the brain is nothing more than a mere 
pulpy mass, without any kind of function or use to the individual 
in possession of the same; the one is in active and increasing 
operation, the other is but a blank, doing nothing, useless; the 
ganglionic nervous system executes its function instinctively, 
whereas the brain, if not the spinal cord, requires time and expe- 
rience and direction ere it perform its functions, either for good or 
for evil Dr. Davey compared the monstrosity of Dr. M. Hall, 
organically considered, to the lower classes of animal life, the 
medusariae; these, he said, performed functions of an instinctive 
and preservative character,' executed those functions only which 
are strictly vital, such as secretion, absorption, nutrition, and so on ; 
and therefore was it to be inferred, and most fairly and logically, 
that these same animals were possessed of a sympathetic nervous 
system and none other ; the nervous organism of both the amy- 
encephalous monster and the zoophyte was precisely similar, and 
their animal functions were on a par. As a further illustration of 
the opinions advocated, he cited some rare examples of vivisections 
performed by himself with the view of testing anatomically the 
relative importance of the ganglionic and cerebro-spinal nervous 
centres. It was shown that in frogs and fish both the brain and 
spinal cord may be destroyed, and that, nevertheless, all the 



THE EXCITO-SECRETORY SYSTEM OF NERVES. 93 

strictly vital functions will continue to be carried on as before. 
These animals, it was observed, offered peculiar facilities for the 
performance of such experiments, from the peculiarity of their 
respiratory apparatus ; but, added the author, you have only to 
establish an artificial respiratory process or function in the higher 
order of animals, i. e., those who breathe normally with the aid of 
a complex set of nerves and muscles, for that which is purely 
natural, and then may the spinal cord and brain be destroyed with 
an almost equal impunity, so far as the said vital acts are concerned 
in them. The phenomena of sleep and disease were referred to as 
offering strong and corroborative evidence of the physiological 
opinions insisted on ; and, in so far as the latter is concerned, Dr. 
Davey mentioned that the wards of any lunatic asylum would 
afford many instances of individuals who were reduced to a mere 
vegetative or organic existence by disorder affecting the brain and 
spinal cord ; such patients, he said, lived oftentimes many years 
with their cerebro-spinal organism so disorganized as to be per- 
fectly useless to them; unconscious, without feeling, emotion, or 
desire, void of thought, without hope, joy, or passion, lost to all 
normal sensation, or, perhaps, without feeling of any kind, and in- 
capable of only the most imperfect motive power, enfeebled, para- 
lytic, they nevertheless digest, secrete, absorb, in a word, carry on, 
year by year, the strictly vital functions, exactly as the malorgan- 
ized foetus does ; exactly as the frog or fish, deprived of the brain 
and spinal cord, did; and exactly as the polypus is in the habit of 
doing. He then referred the Society to the experiments of Sir B. 
Brodie, performed many years since, for the purpose of proving 
that those nerves having a cerebro-spinal origin had no kind of 
influence on the reparation of injuries, and so on. Frogs, guinea 
pigs, and dogs, were the subjects of Sir B. Brodie's experiments; 
and it was found that the destruction even of the lumbar spinal 
cord, much less that of the crural and sciatic nerves, neither re- 
tarded nor impaired, in any way, the reparative process in the 
lower extremities; 1 thus, wounds and fractures made in the limbs 
so deprived of cerebro-spinal nervous influence healed and united 
as readily and completely as under all ordinary circumstances. 
Dr. Davey explains the facts recorded by Sir B. Brodie by saying 
that the ganglionic nervous power was necessarily left intact, and 

1 The more recent experiments of Brown-Sequard only corroborate these results 
of Sir Eenjamin Brodie's experiments. 

8 



94 prize essay: 

this it was which caused the wounds to heal and the fractures to 
unite, and insisted on it that, although great and serious injuries to 
the brain and cord were borne with impunity, and for the reasons 
above stated, yet were such altogether impossible in so far as the 
solar ganglion and its dependencies were concerned. It was very 
truly said that a comparatively feeble blow on the epigastrium over 
the solar ganglion would destroy life, and that it was a very 
common thing among boys to suffer greatly from slight and acci- 
dental blows taking effect on the pit of the stomach ; and the great 
danger of physical violence, even in a slight degree, to the epigas- 
trium was well known to the prize-fighting gentry, who forbade 
the combatants to strike below the sternum; and if, as the author 
asserts, the solar ganglion be the seat of life, the locale of the 
impetum faciens of old writers, the irritability, the motions without 
force, of Haller, then can we easily account for the facts just 
cited." 1 

From a consideration of the facts in relation to the monstrosities 
here adduced, and also from the analogies to be found in the animal 
kingdom and in pathological records, also referred to, we find that 
an independent existence can be maintained under the sole influence 
of the secretory system of nerves. But the human being, in its 
extra-uterine life, and also most of the lower animals, are not mere 
vegetative existences, but organisms, maintaining relations with the 
external world. In the normal condition, there are no independent 
entities among the higher classes. For, maintaining external rela- 
tions, the being is endowed, as we have seen, with a nervous sys- 
tem of relation, which is the cerebro-spinal, the other grand divi- 
sion of the nervous system. This cerebro-spinal system has been 
subdivided into two portions, viz., the nerves of sensation and those 
presiding over muscular action. A relation has been discovered to 
subsist between these two portions of the nervous system, by virtue 
of which the sensory nerves have been found to act as excitors to 
the motory ; and hence thi^ system has been termed by Dr. Mar- 
shall Hall the excito-motory system of nerves. Now, as we hope 
more fully to set forth in the present discussion, these same sensory 
nerves are not only excitors to the motory system, but, under certain 
circumstances, most of them sustain an analogous relation to the 
secretory nerves, exciting them, and modifying their action, dimi- 

1 On the Physiological Uses of the Ganglionic Nervous System, American 
Journal of Medical Sciences, vol. xxvi. p. 457. 



THE EXCITO-SECRETORY SYSTEM OF NERVES. 95 

nishing, increasing, and altering the secretions, according to the 
extent and character of the excitation applied. It will be our 
object, then, to show that the sensory nerves, or, at least, some of 
them, sustain to the other two portions of the nervous system a 
double relation : first, excitors to the motory system, giving rise to 
the excito-motory sj^stem described by Dr. Marshall Hall in 1837; 
and, 

Secondly, excitors to the secretory system, resulting in the excito- 
secretory System, enunciated first in this country in the year 1850, x 
and which second system Dr. Marshall Hall did not appear any- 
where to recognize until the present year, 1857. 2 

In the establishment of our proposition of the excito-secretory 
function of the nervous system, we will present and discuss certain 
phenomena of the animal economy, which we think will answer 
well our purposes of illustration. 

We have said that the cutaneous sensitive nerves are the excitors 
to the secretory system as well as to the motory. It has long been 
observed that there exists a well-marked correlation between the 
cutaneous surface without and the secretory surfaces within, and 
that the action of these organs is influenced in a marked degree by 
impressions made upon the external surface. The sudden exposure 
of the body to a cold atmosphere, or to a cold stream of water, it 
is well known, will increase the urinary secretion. 

These phenomena have been variously explained. One of these 
explanations is, that there subsists an antagonism between the 
cutaneous surface and the secretory surfaces of the kidney, or the 
bowels, as the case may be. This doctrine of antagonism we 
regard as entirely unphilosophical, whether applied to the kidney, 
to the mucous surface of the bowels, or to any other portion of the 
animal organism. There is no such principle, in our humble 
opinion, as antagonism to be recognized in any of the operations 
of nature in her conduct of the vital processes, but a beautiful cor- 
relation and reciprocity are everywhere manifest in her economy. 

1 An Essay on the Influence of Dentition in producing Disease. By Henry F. 
Campbell, M. D., Demonstrator of Anatomy in the Medical College of Georgia. — 
Southern Medical and Surgical Journal, vol. vi., June, 1850. 

We deem it proper here to state that all reference, either by note or in the text, 
to the previous publications of the author of this essay, were excluded from the 
manuscript presented to the committee ; these annotations have been made subse- 
quently to the award of the prize by special permission. 

2 London Lancet, March, 1857, Amer. ed. 



96 PEIZE essay: 

Nor yet again can we justly account for these sequences upon the 
theory of revulsion, or a driving in of the blood upon the secretory 
organ. The real explanation is far more simple, and far more in 
accordance with the recognized principles of action in the nervous 
Sj'stem. Under favorable circumstances, we irritate an excitor 
nerve and we stimulate muscular contractions, evidencing the ex- 
istence of the excito-motory function. Now, under the circum- 
stances above related, the excitor or sensitive nerves, having 
received an appropriate stimulus, excite, through the medium of 
the spinal centres, the action of those ganglia and filaments 
dominating the secretory organs in question; they control, as 
we have seen, their circulation ; they preside over their secretion, 
and thus stimulated, they are excited to modify the circulation and 
the secretion. So far, this is a normal act, the result of that 
ordained and wholesome correlation established between these two 
portions of the organism through these two systems of nerves, the 
sensory and the secretory ; but, should the excitation be unusually 
strong, amounting to what is popularly termed a " shock," or too 
prolonged, we find the secretory system acting unduly, and this 
action is then carried to an abnormal extent ; the dynamic act so 
modifies the circulation that secretion becomes aberrated, or even 
arrested, and, perhaps, a change in the condition of the tissue from 
altered nutrition may result. Dr. Marshall Hall thus remarks, in 
his recent article' upon this subject: "A partial keen current of 
air, falling on any susceptible portion of the skin, may induce in- 
flammation in any susceptible internal organ. An extensive burn 
or scald is apt to induce pneumonia." 

It is in this way, then, viz., by the doctrine of the excito-secretory 
function of the nerves, that the above familiar, though, until a few 
years past, mysterious phenomena, have received their interpreta- 
tion. But in order to study the excito-secretory system in its most 
definite and obvious relations, it will be necessary to select some 
portion of this system wherein a single excitor-nerve will be found 
to exercise its influence over an extended region, becoming pro- 
ductive of a diversity of results. W© have already examined some- 
what in extenso the distribution and connections of the fifth pair of 
nerves; we now select this portion of the nervous system as the 
most suitable excitor, the discussion of whose connections and phy- 

1 London Lancet, March, 1857, American edition. 



THE EXCITO-SECRETORY SYSTEM OF NERVES. 97 

siological relations, upon which we may illustrate the principle of 
excito-secretory aetion. We have seen that in its distribution it is 
displayed upon parts endowed with the most exquisite sensibility ; 
that its connections with the secretory system are most intimate 
and abundant, a portion of the ganglionic system being engrafted 
upon it ; aud that, finally, in its central attachment, it is found im- 
planted into that portion of the cerebro-spinal axis, which is gene- 
rally conceded, and which the recent experiments of M. Bernard 
have demonstrated to exercise a more extensive influence over the 
vital- processes of the organism than any other one portion, viz., the 
medulla oblongata. 1 This fifth nerve thus centrally connected, will 
be recollected to send certain filaments to the sensitive parts about 
the eye, certain others to the teeth, and also sensitive branches to 
the head and face. 

What, then, are some of the phenomena occurring in the region 
of this nerve which are found to illustrate the function of excito- 
secretion? We think that the instances are varied and abundant. 
First, then, in regard to the eye particularly : under certain circum- 
stances, the sensitive conjunctival surface of the ocular globe is 
exposed to a sudden draft of air, or to some more mechanical irri- 
tant. The first effect occurring from this exposure is, an immediate 
increase in the secretion of the lachrymal gland. This may con- 
tinue, or it may be entirely arrested after continuing for a time. 
Secondly, the eye becomes perhaps dry, or it may become congested 
and secrete a puriform fluid, which, drying, closes the lids; or it 
may become entirely hloodshotten or ecchymosed, and in very favora- 
ble conditions, ulceration and even opacity of the cornea may result 
from this " taking cold." This is a condition of the parts, though 
arrived at much more gradually, which we find resulting from the 
experiments so repeatedly referred to in this paper, and our ex- 
planation of them is, that the sensitive fifth nerve becomes excitor 
through the spinal centre, to the modifications in the circulation, 
secretion, and nutrition of the eyeball, which acts are under the 
immediate reign of the ganglionic system. We can observe the 
same character of phenomena in the secretory lining membrane of 
the nostril; and also the same exposure to cold may, through the 

1 " Which last (the medulla oblongata) may no doubt be considered to be inter- 
mediate between the ganglionic and spinal systems, and partaking to some extent 
in the attributes of both." — Prize Essay on the Arterial Circulation in its Physio- 
logy and Chief Pathological Relations. By Henry Hartshorne, M. D. — Transac- 
tions of Amer. Med. Association, vol. ix. 



93 PRIZE ESSAY: 

fifth nerve, or other sensitive nerves, excite modified circulation in 
the fauces and pharynx through the secretory or mixed branches, 
which, together with the pharyngeal plexus, control the circulation 
of those mucous surfaces. 

We will now refer to another form of irritation, and more local, 
but attended by almost identical results. How much a subject of 
every day observation has it become, that certain irritations in the 
buccal cavity are competent to affect the circulation of the eye ! A 
few months since, we were in attendance upon a case wherein an 
eye which had previously been operated upon; after entire immu- 
nity from disease of every kind, became first slightly affected with 
linear congestion, the lachrymal secretion was greatly increased, 
then it became painful and bloodshotten, with slight ulcerations 
upon the cornea. This condition had continued for over a month, 
when, at the suggestion of a distinguished friend, 1 a carious tooth 
was extracted from the upper jaw of the side corresponding to the 
affected eye. The result was most marked and satisfactory; the 
pain, the flow of tears, and the congestion rapidly subsided, the 
parts regained their natural state, and the patient was entirely re- 
lieved. To trace the nervous connections, and to give the rationale 
of the above phenomena, is scarcely necessary at this stage of our 
discussion. Suffice it to say, that the dental irritation was here 
propagated to the spinal centre giving origin to the fifth nerve, and 
was then reflected upon the eye, lachrymal gland, &c, through the 
ganglia and filaments of the secretory system, controlling the nutri- 
tive and secretory processes of the eye. 

In a consideration of this relation of the teeth to the sensory or 
excitor branches of the trifacial, and through them to the spinal 
marrow, and thence to the entire secretory system, is to be found 
nearly all that is necessary for the full portrayal of the excito- 
secretory system. For in the phenomena which sometimes result 
from these relations under peculiar circumstances, are to be found 
illustrations of almost every character and degree of modified secre- 
tion and nutrition. Let us, as has been done by us on former occa- 
sions, 2 here examine the varied phenomena of that period of in- 

1 Prof. Paul F. Eve, of Nashville, Tenn. 

2 See Essay, above cited, on the " Influence of Dentition in producing Disease." — 
Southern Medical and Surgical Journal, June, 1850. 

Secondly. Article on " Sympathetic Nerve in Reflex Phenomena." By Henry F. 
Campbell, of Georgia. — Transactions of American Medical Association, vol. vi., 
May, 1853. 

Thirdly. A letter to Dr. Marshall Hall, of London, entitled, "A Claim of Priority 



THE EXCITO-SECRETORY SYSTEM OF NERVES. 99 

fantine existence ordinarily termed the process of dentition. At 
this time the growing teeth begin to press upon the surrounding 
parts, which parts, and the teeth themselves, are supplied by the 
filaments from the fifth pair of nerves; the gums become sensitive, 
evincing great local irritation. Besides this local irritation, there 
are very generally other, and some of them much graver, affections 
attending the process of dentition, many of them, plainly, well- 
marked instances of aberration in secretion and nutrition. Thus 
the eye becomes lachrymose and congested, the Schneiderian mem- 
brane is also congested^and pours out an abundant secretion; the 
secretion of the intestinal mucous membrane is altered and increased 
to such an extent as to produce " the diarrhoea of teething," or 
cholera infantum. 

In the discussion of these affections we do not wish here to 
occupy much space, as they have been fully, and, we think, ration- 
ally explained elsewhere. 1 Another class of affections, however, 
which attend the period of dentition, have never elsewhere been 
satisfactorily accounted for, nor their etiological connection with 
this process clearly made out; all admit that they are concomitants 
of dentition, but no one has ever explained how they may be the 
results of that process of evolution. We refer to those trouble- 
some cutaneous eruptions so common among teething children. 
That they have a connection with this process, their popular name 
will plainly indicate, for some of them are called "tooth rashes" in 
common parlance. These eruptions, as is well known, vary much 
in character and degree, the milder being a mere roseate suffusion, 
while others assume the more refractory forms of vesicular, papula?, 
squamse, &c. &c, which are apt to continue during the whole 
period of teething. 

Now, for these concomitants of dentition, there had never been 
presented any rational and satisfactory explanation, until they were 
referred to as illustrating the doctrine of excito-secretory action in 
1850. 2 A comprehension of this doctrine affords to them a ready 
interpretation by referring them to the modified action of the secre- 

in the Discovery and Naming of the Excito-secretory System of Nerves." By 
Henry Fraser Campbell, M. D., Member of the American Medical Association, 
&c. &c 

The above letter has been transmitted to the London Lancet for publication, and 
was published in this country in the Southern Medical and Surgical Journal, April, 
1857. This claim was laid before the Association at its last meeting in May, 1857. 

1 Essay above cited, 2 Loc. citat. 



100 PRIZE ESSAY: 

torj system controlling the capillary circulation of the cutaneous 
surface, which modification is excited through the dental filaments 
of the fifth pair, the spinal marrow, and that portion of the gan- 
glionic system above referred to. 

The verification of the above view of the influence of these con- 
nections, and also of the effect of the local irritation, we ask leave 
here to adduce an observation which we are not aware has been 
recorded elsewhere. It is generally admitted that at the termina- 
tion of the period of dentition, that is, when the child has acquired 
all its teeth, the cutaneous eruption, of whatever nature it may have 
been, subsides, and the skin resumes its natural condition, the pa- 
tient not again being liable to its return. This, according to our 
observation, is generally, but not invariably, the case. We have 
observed certain instances in which the eruption had subsided for 
several years, when on the advent of the second dentition it came 
out with almost its former violence and inveteracy, not subsiding 
until the second period was entirely completed. So frequent has 
this return of the eruption been a subject of remark with us, that 
we now seldom encourage parents to expect permanent relief for 
their children, affected with these eruptions, until after the comple- 
tion of the second dentition. Again : we find that children who have 
suffered severely during the period of dentition, are very liable to 
become affected with dropsy, this latter affection frequently present- 
ing itself as the termination of the above cases. Since the announce- 
ment of the excito-secretory function of the nervous system, these 
cutaneous eruptions and dropsical affections which occur during 
dentition, in our opinion, need no extended and elaborate explana- 
tion. We deem it, however, proper to refer to the significant and 
most apposite fact, that when Dupuy extirpated the superior cervi- 
cal ganglia in horses, " there resulted an eruption over the vjhole cu- 
taneous surface, with emaciation and an cedematous state of the limbs f 
may we not trace the cause of these analogous states occurring in 
dentition, to the prolonged aggression made by the dental irritation 
through the fifth nerve upon those secretory centres which control 
the capillary circulation of the cutaneous surface. 

We are aware that the above phenomena, indicating embarrassed 
or aberrated action in the secretory system of nerves, might re- 
ceive an explanation in the fact, that during this period several of 
the important emunctories of the system, as the liver and the kidney, 
suffer an arrest, or at least a modification in their eliminatory func- 
tions; but we will not contend here for the difference in the value 



THE EXCITO-SECRETORY SYSTEM OF NERVES. 101 

of these two opinions; either one of them can only rationally ex- 
plain the phenomena by invoking the aid of the excito-secretory 
action originated by the irritation caused in the branches of the 
trifacial during the evolution of the teeth. 

The urinary secretion is much influenced throughout the period 
of dentition. "Hunter, 1 and afterwards Underwood," 2 says Dr. 
Laycock, 3 "remarked the connection between the teeth and the 
kidney and bladder in children; the growth of the former being 
accompanied with increased flow of urine, symptoms of gonorrhoea, 
and of stone in the bladder, and involuntary micturition. Mr. 
Bingham corroborates these observations," &c. At an early period 
of our connection with the study of medicine, we were led to in- 
vestigate the relation which the process of dentition bore to this 
particular set of concomitants, and in the consideration of these 
relations were first traced out those connections between the cere- 
brospinal excitor nerves and the ganglionic secretory nerves which 
constitute the basis of the excito-secretory function in every por- 
tion of the organism. Our observation, then, led us to the opinion 
that this increase of renal secretion was caused by reflected peripheral 
irritation from the growing teeth upon the dental branches of the 
fifth pair, which irritation being transmitted to the spinal centre 
giving origin to this sensitive nerve, rendered it an excitor to the 
secretion of the kidneys through the ganglionic system presiding 
over that particular function. A more thorough investigation of 
the anatomical relations of the trifacial, and especially of its final 
central connection with the cerebro-spinal axis, have only served to 
strengthen the above convictions, and while placing our observed 
facts in philosophical relation with some of the recent experiments 
of M. Claude Bernard, of Paris, 4 we are more fully convinced of 
their significance. Dr. Alcock 5 thus traces the trunk of the trifa- 
cial from the surface of the crus cerebelli to its real origin : " The 
course of the larger packet" (which is the sensitive) " is also be- 
neath and before that of the lesser, and hence in the usual mode of 
dissection, in which the brain is reversed, it presents itself first. 

1 The Natural History of the Human Teeth, p. 234. 

2 On Diseases of Children. Ninth edition, edited by Dr. Marshall Hall; p. 252. 
London, 1835. 

3 Essay on Hysteria, p. 86, American edition. Philadelphia, 1840. 

4 Vide Lemons de Physiologie. Paris, 1854 and 1855. 

5 Cyclopedia of Anatomy and Physiology, vol. xi. p. 271, art. Fifth Pair of 
Nerves. 



102 PEIZE ESSAY: 

Its direction is backwards, downwards, and inwards, towards the 
upper extremity of the spinal bulb ; . . . . it is then situate in the 
angle formed by the three peduncles of the cerebellum at their 
junction with the hemisphere; behind the middle, beneath the su- 
perior, and above the inferior, and before — or in common language, 
beneath the floor of the fourth ventricle.'' 1 He further quotes Scemer- 
ring, 1 that "it appears to arise almost from the very floor of the fourth 
ventricle." The following lignograph, No. 140 Todd's Cyclopedia of 
Anatomy and Physiology, will more fully illustrate the central con- 
nection of the fifth pair. 

Fig. 3. 




Lateral View of the Pons, Spinal Bulb, and Course of the Fifth Nerve in Man. — 1. Pons Va- 
rolii. 2. Spinal bulb. 3. Olivary body. 4. Spinal cord. 5. Superior peduncle of cerebellum. 
6. Cut surfaces of middle cerebellum. 7. Inferior peduncle of cerebellum. 8. Cut surface of crus 
cerebri. 9. Ganglion of fiftb nerve reversed. 10. Ganglionic portion of tbe nerve. 11. Non-gan- 
glionic portion of fiftb nerve. 11'. Boots of non-ganglionic portion. 12. Eminence at tbe insertion 
of botb portions of tbe fiftb nerve. 13. Fasciculus to anterior column of spinal cord. 14. Fasci- 
culus to posterior column. 15. Auditory nerve. 16. Portio dura. 17. Posterior roots of superior 
cervical nerves. 

" I have adopted," says Erasmus Wilson, 2 " the origin of this 
nerve given by Dr. Alcock, of Dublin, in the Cyclopedia of Anatomy 

1 De Corpori Humani Fabrica. 1798. 

2 Dissector's Manual of Practical and Surgical Anatomy. Second edition. 
London, 1853. P. 341, note. 



THE EXCITO-SECRETORY SYSTEM OF NERVES. 



103 



and Physiology, as the result of his dissections. Mr. Mayo also 
traces the anterior root of the nerve to a similar origin." 

We also here adduce the high authority of Dr. R. B. Todd 1 in 
relation to the connection of the trifacial with the floor of the fourth 
ventricle. "The ordinary columns are seen distinctly in their 
ascent to the brain in the fourth ventricle, as two cylinders (A, F, 
Fig. 4), which form the floor of that cavity We here see dis- 
tinctly that these columns" (which form the floor of the fourth 
ventricle) M are the source of origin of these nerves (the seventh 
pair), and no doubt they are equally so of all the nerves which are 
connected with the medulla oblongata, namely, the fifth pair, the 
eighth, the ninth, and probably also the sixth." The cut used by 
him is taken from Foville, and we here introduce it. 



Fig. 4. 




Posterior View of the Medulla Oblongata, with Mesocephale and part of Cerebellum of an 
Infant.— S. Pineal gland. D. Nates. D'. Testes. + +• Points of emergence of fourth pair of 
nerves. Y. Posterior pyramids. X. Eestiform columns. A, F. Floor of the fourth ventricle, formed 
by the olivary colnmns, the fissure between which is the calamus scriptorius. T'. Posterior 
surface of mesocephale. B. Valve of Vieussens. N. Anterior surface of crus cerebri. K. Corpus 
dentatum or rhomboideum. 

Some time in 1852 (so far as we can ascertain by reference to 
records at hand), Mons. C. Bernard, of Paris, performed certain 

1 Descriptive and Physiological Anatomy of the Brain and Spinal Cord and 
Ganglions, &c, p. 177. London, 1845. 



104 PRIZE ESSAY: 

experiments to determine the influence of the galvanism of certain 
nerves upon the secretory functions of various organs. Having 
abandoned these, he next instituted others, which more recently we 
find clearly and satisfactorily illustrated in his lectures delivered at 
the College of France during the sessions of 1854 and 1855, and 
published, Paris, 1855 and 1856. 1 These brilliant experiments have 
won for M. Bernard a well-earned and enduring fame, and have 
done much towards the advancement of physiological science. 

" We find," says a recent writer, 2 " as might be expected, minute 
details regarding the mode in which Bernard performs his cele- 
brated experiment of inducing artificial diabetes by pricking a 
certain point of the medulla oblongata either of a herbivorous or a 
carnivorous animal ; but, until we read these lectures, we were not 
aware that he had extended his experiment in the manner described 
in the following paragraph : ' When we prick the mesial line of the 
floor of the fourth ventricle in the exact centre of the space between 
the origins of the auditory and pneumogastric nerves, we, at the 
same time, produce an exaggeration of the hepatic (saccharine) and 
of the renal secretions ; if the puncture be effected a little higher, 
we very often only produce an augmentation in the quantity of 
the urine, when this frequently becomes charged with albuminous 
matters, while if the puncture be below the indicated point, the 
discharge of sugar alone is observed, and the urine remains turbid 
and scanty. Hence it appears that we may distinguish two points, 
of which the inferior corresponds to the secretion of the liver, and 
the superior to that of the kidneys. As, however, these two points 
are very near to each other, it often happens that, if the instrument 
enters obliquely, they are simultaneously wounded, and the animal's 
urine not only becomes superabundant, but, at the same time, sac- 
charine.' " We here copy a cut from Bernard, showing the relation 
of the parts, and the point of pricking the floor of the fourth ven- 
tricle. 

It will be seen, by examination of the above figure, that the 
place indicated for introducing the point, i, of the piercing instru- 
ment, /, in order to increase the secretion of urine, and to change 
its character, is very near to the implantation of the root of the 
fifth pair of nerves, g, in the following figure. Hence, we may 
fairly say that the above operation, performed, as it appears from 

1 Lemons de Physiologie Experimental, &c. 

2 British and Foreign Medico-Chirurgical Preview, No. xxxvii., Jan., 1857, p. 32. 



THE EXCITO-SECRETORY SYSTEM OF NERVES. 



105 



M. Claude Bernard's work, 1 on the 13th of February, 1855, proves 
experimentally that irritation made in a spinal centre is competent 

Fig. 5. 




Section of a Rabbit's Head to show the Direction of the Perforation, a. Cerebellum, b. 
Origin of the seventh pair of nerves, c. Spinal marrow, d. Origin of the pneumogastric nerve, e. 
Orifice by which the instrument enters the cranium. /. Instrument, g. Fifth pair of nerves, h. 
Auditory canal, i. Extremity of the instrument reaching the medulla after traversing the cerebel- 
lum, ft. Occipital venous sinus. I. Tubercula quadrigemina. m. Cerebrum, n. Section of the 
atlas. 

to excite and to modify the secretory function of the abdominal 
viscera, which function is exercised under the reign of the gan- 
glionic system, the parts in which it goes on being only inter- 
mediately connected with that spinal centre thus irritated. This 
fact, thus proved in experiment by M. Claude Bernard, the records 
of American medicine will show, was recognized and announced 
from observation in June, 1850. 2 In M. Bernard's experimental in- 
vestigation, the irritation was applied directly to the nervous 
centre; in the induction from observation, peripheral irritation 
through the dental branches of the fifth nerve was recognized as 
competent to excite the secretion, and modify the products of secre- 
tion. The observation here, and not the more recent experiment, was 
the real parent of the principle of cxcito-secretion. The conclusion 
arrived at, from the observation of pathological phenomena, em- 

1 Op. citat., p. 288. 

2 Southern Medical and Surgical Journal, vol. vi. p. 321. 



106 PRIZE essay: 

braced all the elements of the excito-secretory function, viz: first, 
a sensitive nerve as an excitor ; secondly, a cerebro-spinal centre ; 
thirdly, the secretory nerves and ganglia. M. Bernard's experi- 
mental results were deficient in the first of these elements, viz., the 
sensitive nerve as an excitor. 1 

To illustrate the connection of these various parts with the two 
divisions of the nervous system, we have introduced another figure 
from page 322 of M. Bernard's excellent work : — 

In transferring to our pages the next figure, we have omitted 
the explanations, but would here remind the reader that analogous 
relations subsist between the secretory filaments of the alimentary 
canal, not represented here, and the cerebro-spinal centres and 
cerebro-spinal sensitive branches. 

We will make special reference to only one more set of patholo- 
gical phenomena, as peculiarly illustrative of the excito-secretory 
function of the nervous system; we refer to some of those very 
mysterious aberrations of secretion found so uniformly concomitant 
with attacks of hysteria. Almost universal opinion has referred the 
manifesations of this disease to irritation of one kind or another, 
in the generative organs of females, viz., the ovaria, neck of the 
womb, and the uterus itself. It is a significant fact, that females 
laboring under this disease should so frequently manifest modifica- 
tion in their urinary secretion. "It appears, indeed," says Lay- 
cock, "that some alteration in the quantity or composition of the 
urinary secretion is one of the most constant symptoms of hysteria, 
even in its mildest form, when the patient can only be said to have 
a hysterical constitution." 2 "Limpid urine," in large quantities, is 
nearly always a concomitant, and Dr. Laycock also refers to "the 
profuse sweats and salivation of hysterical females." We regard 
all these secretory phenomena as fully explicable, by referring them 
in many instances to the excito-secretory function. 

The records of both physiological and pathological medicine, 
would furnish a still more abundant treasure of facts, which could 
be made to corroborate our views in reference to this function of 
the nervous system, but such an extended discussion would not be 
consonant with the object of the present paper. Our earnest endea- 

1 We have not tested in any instance the chemical properties of the urine of 
teething children, but we would here respectfully suggest that it will be found to 
contain sugar in those cases in which the increased urinary secretion presents a 
prominent feature in the concomitants of dentition. 

2 Op. citat., p. 86. 



THE EXCTTO-SECRETORY SYSTEM OF NERVES. 



107 



vor has been to bring together from all sources, however diverse 
and unpromising, a sufficient number of kindred facts, to establish, 



Fig. 6 




Cerebro-spinal and Splanchnic Nervous Systems of a Kabbit, snowing the nervous connections- 
existing between the liver, lung, and kidney, to explain the production of artificial diabetes. 



108 PRIZE ESSAY. 

more fully, perhaps, than has heretofore been done, the physiological 
and pathological relations of the excito-secretory system of nerves. 
This dissociation of old facts from their accustomed and apparently 
established relations, and the transferring of them to new ones, may 
have given to our discussion an aggressive aspect,- by no means 
intended or contemplated by us. We disclaim all intention to un- 
derrate the importance of other investigations, or to misinterpret 
their results. We have, in a few instances, it is true, endeavored 
to the best of our ability to correct the conclusions of some who 
have preceded us, but never, for a moment, prizing less the real 
significance of the data in discussion. " The ultimate attainment of 
truth," writes the great Sir William Hamilton, 1 "has ever been by 
gradual approach" and, as not unkindred to our theme, we quote 
his apt illustration : " The history, in regard to the discovery of the 
distinction between sensitive and motor filaments in the nerves, 
finally established by Sir Charles Bell, was only the last of a long 
series of previous observations tending to the same effect ;" or, in the 
words of Professor Whewell, " the facts were known, but they were 
insulated and unconnected till the discoverer supplied, from his 
own stores, a principle of connection. The pearls are there, but 
they will not hang together till some one supplies the string." 2 By 
diligent observation and careful induction, we have, for years past, 
been endeavoring to find this principle of connection, and to place 
these pearls upon their appropriate string; if, in the earnest and 
honest investigation of a somewhat new and obscure subject, we 
have failed to develop all that the advantages, previous suggestions, 
and the rapid progress of science must unfold in this extensive field 
of inquiry, we can only refer to the recent expression of Dr. Mar- 
shall Hall, 3 that " this vast subject demands a most extensive and 
cautious series of experiments and observations. The efforts of many 
laborers, through many years, will be required fully to develop the 
two sub-systems of the Diastaltic Nervous System." We must 
cordially agree with him, but would here humbly, but most earn- 
estly ask, that "observation" be allowed to occupy her true and 
equal place by the side of "experiment" in all these investigations. 

1 Philosophical Works, p. 400, note. 

2 Philosophy of the Inductive Sciences, vol. ii. p. 48. 

3 London Lancet, March, 1857, American edition. 



IV. 



A CLAIM 



or 



PRIORITY IN THE DISCOVERY AND NAMING 



EXCITO-SECRETORY SYSTEM OF NERYES. 



[FOR THE LONDON LANCET.] 



LETTER. 

Augusta, Georgia, U. S., March 2, 1857. 
To Marshall Hall, M. D., of London, F.R. S., &c. 

My Dear Sir — In the number of the London Lancet republished 
in this country, for March, 1857 (present month), I have just read 
a paper from your distinguished pen ; and in this paper you an- 
nounce a system of Excito -secretory Nerves, in the following 
connection and in the following terms : — 

"In a memoir read at the Royal Society in February, 1837, I 
announced the existence of an Exctto-motory system of Nerves. 

"I believe I may now announce a system or sub-system of 
Excito-secretory Nerves, not less extensive." 

As the above announcement is here made in close relation with 
a discovery long admitted to be your owd, viz., that of the Excito- 
motory system of nerves, and inasmuch as in your subsequent re- 
marks you attribute the proposition to no one else, I am left to 
infer that it is deemed by you an original deduction from the 
admitted facts of Anatomical and Physiological Science, as de- 
veloped by observations and experiments during the last and the 
present century. Some of these last — viz., the experiments of 
Mons. Claude Bernard, of Paris — you adduce with the apparent 
intention of fortifying the views you here express. 

Finding in none of your communications upon this interesting 
topic, any mention made of my name or of my records, I am, with 
regret, impelled, from considerations of courtesy to you and of 
justice to myself, to call your attention to the registration of my 
own labors in the same important field. I will, however, first 
direct you particularly, though briefly, to several portions of your 
own communication, in order that they may be placed in conveni- 
ent juxtaposition with my own records,' without giving the trouble 
of each" time referring to the pages of the Lancet: 



112 CLAIM TO PKIOEITY IN DISCOVERY 

" But the most remarkable proof of the doctrine which I am endea- 
voring to unfold is furnished by the brilliant discovery and skilful 
experiments of M. CI. Bernard" — 

And you here refer to his well known experiments on the pneu- 
mogastric nerve in its relation to the secretions of the liver, pub- 
lished in his Lectures on Experimental Physiology, during the 
winter session of 1854 and 1855. 1 

In the earlier part of your communication (March, 1857), you 
thus annoiMice the addition of this, as you suppose, new sub-system, 
to what you term the "Diastaltic Nervous System," the term 
"henceforth" apparently being used to date the initial moment of 
an era: — 

u Henceforth the Diastaltic Nervous System must be divided into 
two sub-systems : — 

I. The Excito-motory. 
II. The Excito-secretory. 

" The former is extended to the entire muscular system; the lat- 
ter is diffused over the general system as the blood is diffused over 
the system." 

Again, in reference to the Pathological Eelations of the Excito- 
secretory System, you remark : — 

"The Pathology of the Excito-secretory sub-system remains to 
be investigated and traced. A partial keen current of air falling 
on any portion of the skin may induce inflammation in any suscep- 
tible internal organ. An extensive burn or scald is apt to produce 
pneumonia." 

And as my last quotation for the present : — 

"But here I close this brief communication. My present object 
is only to draiv the merest sketch of this vast subject which demands a 
most extensive and cautious series of experiments and observations. 
The efforts of many laborers, through many years, will be required 
fully to develop the two sub-systems of the diastaltic nervous sys- 
tem. 

"I propose shortly to treat this important subject at greater 
length and with more details." 

Now, my dear sir, by a reference to the following series of 
records, running through a period of nearly seven years, you will 
at once perceive that the Excito-secretory function of the nerv- 

1 Lemons de Physiologie, p. 325. Paris, 1855. 



OF EXCITO-SECRETORY SYSTEM OF NERVES. 113 

ous system has been the subject of earnest and diligent inquiry, 
and also of plain record, with me, for a length of time far anterior 
to that at which either yourself or Mons. Bernard had published 
anything on the subject. 

You will herein also perceive, that this system of nerves has 
been plainly recognized and set forth as considered in its relations 
to Pathology, through which, indeed, its Physiology has been mainly 
deduced by me. And, lastly, that this system of nerves, before 
plainly stated and amply discussed, was, as early as May 5, 1853, 
in the presence of the American Medical Association, the highest 
tribunal in the medical sciences within my reach, publicly named 
by me the Excito-secretory: and that too in juxtaposition with 
and contradistinction to, your own discovery, viz., the Excito- 
MOTORY function. 

This name or verbal combination, then, for the very first time, 
printed in the English language, or, indeed, in any other language, 
had not, so far as I can learn, after continued and interested inquiry 
on my part, been printed a second time, until taken from your own 
recent manuscript, it appears at the heading of your paper in the 
March number of the London Lancet (American edition), and thus 
becomes the occasion of the present communication. 

Below, I now present you with certain passages from an article 
on "The Influence of Dentition in producing Disease," read before 
the Medical Society of Augusta, Georgia, in May, 1850, and after- 
wards published in this city, in the Southern Medical and Surgical 
Journal, sl periodical circulating extensively and exchanging with 
all the medical journals in this country and with many of those of 
Europe. Here you will now find these several records presented to 
you seriatim and in that order, together with the dates and accom- 
panying circumstances, in which they were long ago successively 
presented to the profession. 

May 2, 1850. " Dr. Henry F. Campbell read an Essay on the 
Influence of Dentition in producing Disease." — [From Minutes of a 
meeting of the Medical Society of Augusta, Georgia^ 

I will not quote from, or remark upon the essay now, but fully 
hereafter as published below. 

June, 1850. Permit me, now,*respected sir, to refer you to the 
pages of the Southern Medical and Surgical Journal, new series, vol. 
vi. No. 6, June, 1850. (Part I. — Original Communications : Arti- 
cle XV., p. 321). You will, in this place, find the paper just cited, 
published — viz: "An Essay on the Influence of Dentition in pro- 



114: CLAIM TO PRIORITY IN DISCOVERY 

ducing Disease. By Henry F. Campbell, M.D., Demonstrator of 
Anatomy in the Medical College of Georgia." 

Here you will find that I have, in the beginning, sketched pro- 
minently the two orders of phenomena which occur (firing tho 
period of dentition, viz., the convulsive and the secretory, explaining 
the first easily enough, by a reference to the principles of excito- 
motory action laid down by yourself; while the other set of pheno- 
mena I presented in such a manner as that, from them, the excito- 
secretory function of the nervous system became an obvious and an 
unavoidable deduction — by this means mutually establishing a phy- 
siological principle before scarcely ever b*roached or hinted at ; and 
in the second place, leaving no chance to escape the necessary ad- 
mission that this set of phenomena, before perfectly inexplicable to 
the profession, could only be rationally interpreted by the admission 
of that very physiological principle. In doing this, " the two sub- 
systems," as you now term them, were, throughout, kept in close 
relation, but in decided contrast, the one being used, occasionally it 
is true, to illustrate the other, but never for a moment becoming 
confounded with the other. Thus: "Now let us inquire how far these 
'phenomena are dependent upon Dentition; and ANALOGY with the 
excito-motory system will much assist us in our argument. We 
have seen that local irritation can, through this system, produce 
convulsions by the reflex function of the nerves, the sensitive 
branches of the fifth pair becoming excitor to the motory spiinal 
nerves; and so, may. we justly infer, do these same branches, under 
certain circumstances, become excitor to the secretory filaments of 
the sympathetic, distributed so abundantly to the intestinal canal by 
a transmission of this irritation through the various ganglia with 
which it is connected." 

You will also here see that the discussion is carried still further 
into the pathological relations of the then new function, and that I 
have instanced nearly all those localities which you have recently 
adduced, and that I have considered those changes in the blood 
while eliminating the secretions under nervous influence, which you 
in your paper designate by the word methosmatous ; as in the follow- 
ing: "Thus the irritation at first produces simply an exaltation of 
the innervation of the secretory* surfaces, and secretion is more 
active than normal, producing simple diarrhea. A continuance of 
the irritation alters the character of the secretion, and we have the 
various morbid discharges observable during this period. This 
increase and change in the secretion are effected by the agency of the 



OF EXCITO-SECRETORY SYSTEM OF NERVES. 115 

altered function of the nerve upon the arteries from which these 
secretions are eliminated." — (See Southern Medical and Surgical 
Journal, p. 331.) 

Without further remark, at present, I will lay before you that 
portion of this essay which embodies my first record upon the 
excito-secretory function of the nervous system. 

" The period of dentition has ever been regarded one of peculiar 
interest, as well to the pathologist as to the practitioner. That cer- 
tain diseases are more apt to occur during this season, few pretend 
to deny ; but the amount of the symptoms, due to the irritation of 
teething, has been variously estimated, some attributing to this 
cause nearly all the ills to which infancy is liable, while others ridi- 
cule the idea, that a process in itself so purely physiological and 
natural should be regarded ever a cause of disease. 

" The object of our essay is to investigate impartially this impor- 
tant subject with the view of determining, as nearly as possible, to 
what extent the organism is affected by the evolution of the teeth. 
In doing so, it appears to us most rational, as a primary step in the 
investigation, to review briefly the phenomena of both normal and 
anormal dentition, with the view of finding the foundation of the 
pathogenic theory, if such exists, in the physiology of this process. 

M The phenomena observed during easy or normal dentition may 
be briefly summed up as follows : The salivary secretion is increased, 
the gums are swollen, the mouth hot, and the child evinces a dispo- 
sition to press every substance within its reach upon the gums, in 
order to relieve the irritation it here suffers. Later, the gums be- 
come more swollen and softer, the irritation more distressing, and, 
under certain circumstances, the mouth dry and slightly inflamed. 
The child becomes fretful; its sleep is disturbed and feverish, its 
bowels become loose, which latter symptom we frequently observe 
accompanied by nausea and vomiting. There is also described by 
some authors an irritation of the Schneider ian membrane, with in- 
creased secretion, marked by the child rubbing its nose. 

" Cases of anormal dentition are brought more frequently under 
the cognizance of physicians, and their phenomena are hence fami- 
liar to every one. The above symptoms become exaggerated — 
some, which in normal dentition were of trivial importance, becom- 
ing so severe as to threaten the life of the patient. Thus, the gen- 
tly relaxed condition of the bowels, which in easy dentition was 
even beneficial, is now changed to diarrhoea with distressing tor- 
mina and alarming emaciation. The salivary glands, which in easy 



116 CLAIM TO PRIORITY IN DISCOVERY 

dentition manifested their implication only by increased secretion, 
now become inflamed and swollen, till finally their secretion is alto- 
gether arrested, leaving the mouth and tongue dry, parched, and 
painful; and the nervous fretfulness of the normal process is often 
replaced by actual fever, sometimes attended by the most terrific 
convulsions. 

" We have here sketched hastily some of the more prominent 
phenomena of both easy and severe dentition, as we each daily 
observe in practice, and find reported by authors, and we do not 
adduce them at present, as the direct results or consequences of the 
process, but only as its pretty constant concomitants. In referring 
to those symptoms hereafter in the course of our essay, we will 
necessarily enlarge upon and develop more fully some of their cha- 
racteristics. Let us now, with a little attention, enter into an ana- 
lysis of these concomitants of dentition, and endeavor to ascertain, 
whether or not their origin may be found in the process itself. To 
this end, we will consider briefly the anatomy and physiology of the 
parts concerned in this important and often perilous process of evo- 
lution." 

" From the above considerations we are induced to conclude that 
the convulsions are often produced by the irritation of dentition, and 
can be directly referred to this as the sole cause. 

" We arrive now at a point in this somewhat obscure and much 
disputed question which, perhaps, affords more ground for doubt 
than any of the foregoing; viz., a consideration of the pathogenic 
influence of dentition in the cholera infantum or diarrhoea so uniformly 
co-existent with this process. Unlike the convulsions, the analogy 
between which and certain known and established phenomena of 
the excito-motory system, which it is only necessary to refer to, and 
their operation is plain and intelligible, this new set of symptoms, 
if we refer them to the process of dentition, requires us to look yet 
deeper into the mysteries of our nervous organization, and to ven- 
ture still one step further on the terra incerta of sympathetic interpre- 
tation. 

"In order to apply our arguments, let us hastily review the fore- 
going investigation, that they may bear more fully upon this part 
of our question ; and, first, we have seen that inflammation, pain, 
and irritation are produced locally by the process of dentition, 
evinced by restlessness, biting, &c. Secondly, we have seen that 
this local irritation can be transmitted by excito-motory influence 



OF EXCITO-SECRETORY SYSTEM OF NERVES. 117 

to other and distant parts of the body, manifested by convulsions. 
We have also endeavored to corroborate this latter opinion by a 
reference to the order of #uccession in the nerves in which this irri- 
tation occurs, and also by a comparison of these phenomena with 
other well understood and established analogous phenomena. Here- 
tofore we have had to deal entirely with functions of the cerebro- 
spinal system of nerves ; but to account for this second and more 
obscure part of our problem, we must look in vain to any direct 
anatomical connection between the fifth pair and the rest of this 
system of nerves. We are forced to seek out other connections, indeed 
somewhat more intricate and indirect, hut fortunately no less legitimate 
and definable. We have now to consider a set of organs which, 
unlike the voluntary muscles, have no connection, or rather we 
would say, emphatically, they have a connection, though indirectly, 
with the cerebro-spinal system. We mean the abdominal viscera, 
which we know are almost altogether supplied from the great sym- 
pathetic system of nerves. Now, in the prosecution of our inquiry, it 
becomes necessary to the elucidation of the question to trace out the same 
connection between the fifth pair and the sympathetic or secretory, as ice 
did between the fifth pair and the cerebro-spinal or motory nerves, and 
then, should we succeed, we will briefly inquire into the bearing 
which this connection and its possible results may have upon our 
question. 

" The connections between the fifth pair, the rest of the cerebro- 
spinal system of nerves and the great sympathetic, are so abundant 
and universal that it is only necessary to enumerate a few of them to 
illustrate the fact. First, we have a connection in the ophthalmic 
or first division, by its nasal branch communicating with the ciliary 
ganglion ; then in the superior maxillary, or second division, are 
branches of communication with Meckel's ganglion ; again, in the 
submaxillary ganglion, with the inferior maxillary or third division. 
So much for the fifth itself. Then we know that every one of the 
spinal nerves throughout the entire cord are connected to each 
sympathetic ganglion of the system, thus establishing communica- 
tions the most abundant and intimate between these two s} T stems of 
nerves. We know also that these ganglia distribute numerous 
branches to all the splanchnic viscera by plexuses which accompany 
the arterial trunks into the minute structure of these organs. 

" Thus connected and distributed, this nerve presides over the 
important functions of nutrition and secretion, which office so cha- 
racterizes it as to give it the name of the secretory system. In 



118 CLAIM TO PEIOKITY IN DISCOVEKY 

the physiology of the nervous system, there is no fact better esta- 
blished by anatomy and pathology, as well as by experiments on 
the lower animals, than this, that the syrmpathetic nerve, whatever 
else may be its functions, always forms a necessary element in the 
nutrient and secretory apparatus of all the splanchnic viscera ; and 
further, that upon its sanity depends the due administration of these 
two great functions. It is the nerve for the bloodvessels; 'and,' 
remark Todd and Bowman, ' as secretion is mainly dependent on 
the normal nutrition of glands, it is reasonable to suppose that that 
function would be to a certain extent controlled by these nerves.' 
And as early as the year 1732, Pourfour du Petit found that the 
division of the trunk of the sympathetic, opposite the fourth or fifth 
cervical vertebra in dogs, was followed very rapidly by great dis- 
turbance of the circulation of the eyeball, producing inflammation, 
flattening of the cornea, and finally destruction of this organ. 

"The experiments of Dupuy upon the horse, wherein he severed 
this nerve at the superior cervical ganglion, also corroborate this 
statement; general emaciation here ensued, with an anasarcous 
condition of the limbs and an eruption over the whole cutaneous 
surface. 

"In some experiments made by Dr. J. Eeid, and reported by 
Todd and Bowman, in reference to the sympathetic branches sup- 
plying the eye, it was found that the effect of a section of this nerve 
was to produce an immediate injection of the conjunctiva. In one 
case, he observes, the redness of the conjunctiva took place in a 
few minutes after the section. It has been already stated, continue 
these great authors, that a section of the branches of the fifth nerve 
which supply the eye is followed by ulceration and other signs of 
impaired nutrition in the eyeball. But these changes do not take 
place for some time after the section of the nerve — generally many 
days elapse — and they are attributable to the presence of irritating 
particles which, owing to the insensible state of the conjunctiva, are 
suffered to remain in contact with the surface of the eye, giving rise 
to inflammation and uleeration of its textures. The effects of sec- 
tion of the sympathetic are immediate, and are probably due to a 
change produced in the bloodvessels in consequence of the with- 
drawal of the accustomed nervous influence. 

"We have now glanced sufficiently, we think, at the anatomy and 
physiology of the sympathetic system of nerves, to make the appli- 
cation of such points as are pertinent in the solution of our patho- 
logical problem. In its anatomy, we have seen its connections with 



OF EXCITO-SECRETORY SYSTEM OF NERVES. 119 

all three of the divisions of the fifth nerve by ganglia, the connection 
of these various ganglia with each other, as well as with the cere- 
bro-spinal axis ; and lastly, the distribution of branches from these 
ganglia, which are conducted by the arteries into every part of 
every one of the splanchnic viscera. In its physiology, we find it 
in entire charge of the important functions of nutrition and secre- 
tion, and that wherever these processes are effected it is by the 
agency of this nerve alone upon the bloodvessels. And further, 
we have seen that pathology and experiments on lower arnmals 
establish its indispensableness to the due performance of these func- 
tions, and that whenever the supply of its innervation has been cut 
off from a particular part of the organism, that part immediately 
manifests symptoms of impaired nutrition and altered secretion. 

"Now we are all aware that nearly the whole of the intestinal 
canal, or rather that portion between the stomach and lower part 
of 'the colon, receives no direct innervation from the cerebro-spinal 
axis, but is entirely dependent upon the sympathetic nerve for its 
supply of nervous influence of whatever kind it may enjoy, whether 
motory, sensory, or secretory, and consequently an impairment Of 
the function of this nerve must necessarily correspondently alter 
its condition so far as regards all those functions with which this 
nerve endows it. The alteration in these functions would of course 
depend in a great degree upon the amount of impairment in the 
source of irritation; thus, as we have seen, if the supply is entirely 
cut off, the functions of the arteries seem in a great measure to 
cease, passive congestions occur, and the parts inflame and ulcerate. 
Now we can also very naturally conceive of a condition of these 
nerves somewhat analogous to the above, yet intermediate between 
the entire interruption caused by section, and perfect health— a con- 
dition of embarrassed or of exalted innervation. Now this inter- 
mediate condition is exactly the state which, from the developments 
of the foregoing investigation, we feel that we are authorized to 
affirm is that which occurs in severe dentition, and that upon it is 
dependent the whole train of intestinal morbid phenomena observ- 
able during this process. 

"That this, so far, is legitimately inferable, we do not think any 
one will den}>\ Now let us inquire how far these phenomena are 
dependent upon dentition; and analogy with the excito-motory system 
will much assist us in our argument. We have seen that local irri- 
tations can, through this system, produce convulsions by the reflex 
function of the nerves, the sensitive branches of the fifth pair becom- 



120 CLAIM TO PRIORITY IN DISCOVERY 

ing excitor to the motory spinal nerves ; and so may we justly infer 
do these same branches, under certain circumstances, become excitor 
to the secretory filaments of the sympathetic, distributed so abundantly 
to the intestinal canal, by transmission of this irritation through the 
various ganglia with which it is connected. Thus the irritation at 
first produces simply an exaltation of the innervation of these se- 
cretory surfaces, and consequently secretion is more active than 
normal, producing simple diarrhoea. A continuance of the irritation 
alters the character of the secretion, and we have the various morbid 
discharges observable during this period. This increase and change 
in the secretion are effected by the agency of the altered function of the 
nerve upon the arteries from which these secretions are eliminated. Now 
when the innervation of these arteries is still further embarrassed 
by the long continuance of the reflected irritation, the state of things 
nearly approaches that observed in Dupuy's, Eeid's, and Pourfour 
du Petit' s experiments of actual destruction of the nerve, and we 
have ulceration of the intestinal mucous membrane ; all these phe- 
nomena being the result of various degrees of injury sustained by 
the sympathetic nerve. 

"It may here be asked, why should the branches supplying the 
intestinal mucous membrane become more implicated than any 
other portion of the sympathetic system? — and why do not similar 
irritations of the fifth nerve produce like results in the adult? To 
the first of these questions we answer that most probably the other 
portions are implicated, but the manifestations -of such implication 
are greater and graver here than elsewhere, because these are the 
sole sources of innervation to the viscus. The other organs are in 
all probability implicated, but receiving a certain amount of in- 
nervation from other sources, most of their functions not being 
entirely secretory, are still, though imperfectly, carried on. But in 
the intestinal canal the case is far different; the requisitions made 
upon it are of a nature that it has need for no other innervation 
than that of the sympathetic system. Its functions are secretion and 
nutrition for the vjhole animal organism; and when these are im- 
paired, its primary — indeed, its only — intents are altered or com- 
pletely nullified. The second question is answered by the greater 
development of this system in the growing than in the adult indi- 
vidual, for the purpose of supplying the more active nutrition and 
secretion at that time necessary. We know that disease is more 
apt to occur in many parts of the body during this period ; — this is 
the general admission. Thus, according to many authors, among 



OF EXCITO-SECRETORY SYSTEM OF NERVES. 121 

whom are West, Churchill, &c, pneumonia and bronchitis are more 
apt to attack children during dentition than at any previous or 
subsequent period. Cutaneous eruptions, and many other aberra- 
tions of secretion occurring during this period, but serve to cor- 
roborate our theory of the origin of the morbid intestinal secretion. 
The increased vermicular action and tormina attending this affection 
find a ready explanation in the fact, now well established, that the 
sympathetic receives both motor and sensitive filaments from the 
anterior and posterior roots of the spinal nerves, endowing the 
organs of their distribution, to a certain degree, with corresponding 
susceptibilities. 

"In conclusion, let us define the position which, at the end of 
our investigation, we feel warranted in assuming. It is the fol- 
lowing : that in the anatomy and physiology, as well as in the 
dependent analogies of the process of dentition, we find ample 
ground for the opinion that the diseases pertaining to this period 
may be dependent, and in many cases are entirely so, upon the local 
irritation attending the process being transmitted through either the cere- 
brospinal system of nerves, producing convulsive diseases in the motory 
apparatus, or through the sympathetic, causing derangements in the 
secretory organs, particularly the alimentary canal, by the sway which 
it exercises over the arterial system, from which these secretions are elimi- 
nated. And the practical deductions to be drawn from these con- 
clusions are, that we should not be remiss in taking every measure 
to arrest or lessen this local irritation, either by free and repeated 
incisions of the gums, or by the judicious administration of appro- 
priate remedies, among which we have found opiates to prove most 
safe and efficient. 

"It would, indeed, be an improving, and not an unpleasing, 
exercise to trace out more fully the connections between the local 
irritation and the various diseases occurring during the period of 
dentition, to take more extended views of the abundant analogies 
and comparisons afforded by this truly prolific subject ; but time 
and the special object of our essay do not warrant the indulgence 
in speculations so general and discursive. 

"Our object has been to trace the connection between this process 
and diseases in general only in so far as it has a bearing upon the 
establishment of one principal question in reference to the diarrhoea 
of this period. The subject has been only glanced at, and deserves 
a fuller and more extended treatise, wherein all the concomitant 
diseases of dentition, as dropsy, eruptions, and the many infantile 



122 CLAIM TO PRIORITY IN DISCOVERY 

neuroses, should be fully and carefully discussed. Such views we 
would earnestly invite from some abler and more philosophic mem- 
ber of the profession." 

The circumstances of my second published record are the follow- 
ing : At the fifth annual meeting of the American Medical Asso- 
ciation (1852), held in Eichmond, Ya., not being present myself, I 
was appointed a special committee to prepare an essay on the subject 
of Typhoid Fever, which essay was read before that body in New 
York, in May, 1853. In this paper I took occasion to consider 
carefully the ganglionic system, in support of the position therein 
assumed, that all typhoid fevers were manifestations of disease through 
the secretory system of nerves. While thus engaged, my attention 
was called to certain experiments performed by Mons. Claude Ber- 
nard, of Paris, and made public through the Gazette Medicate, and 
translated in the New Orleans Medical Register, together with his 
deductions therefrom. 

On examination, finding that they contained what at that time 
appeared to me the germ of a theory similar to mine, recorded in 
June, 1850, though he refers to them as " a set of phenomena iden- 
tical with those occurring in the cerebro-spinal system of nerves, 
denominated excito-motory by Dr. Marshall Hall," while I had de- 
duced this excito-secretory system (in 1850), saying, " analogy with 
the excito-motory system will much assist us in our argument ;" and 
further, inasmuch as this distinguished gentleman's report presented 
itself to my mind at that time somewhat in the form of an announce- 
ment, I deemed it advisable to appeal to our National Medical Con- 
gress in the following brief memoir, praying permission to record 
before them MY claim to priority, and also my protest against the 
palm of originality attaching to Mons. Claude Bernard. 

[Abstract from the Transactions of the American Medical Association. Meeting 
held in the clty of new york, may 3, 1853.] 

"Dr. Campbell, of Georgia, submitted a paper on a question of 
priority in reference to the discovery of the reflex relation subsist- 
ing between the cerebro-spinal and sympathetic system of nerves." 
— See Minutes of Sixth Annual Meeting, vol. vi. p. 49. 



OF EXC1TO-SECRETORY SYSTEM OF NERVES. 123 



"On the Sympathetic Nerve in Reflex Phenomena. By Henry F. 
Campbell, of Georgia. 

"In a recent number of the Gazette Medicale appear some re- 
marks, 1 by M. Cle. Bernard, on the Keflex Actions of the Nervous 
System. ■ In these he refers one order of such reflex phenomena to 
the sympathetic system of nerves, and illustrates, by experiments 
upon the frog, as well as by reference to many of the acts of nutri- 
tion and secretion, that such a relation exists between the cerebro- 
spinal and ganglionic system of nerves, as well as between the 
excitor and motory portions of the cerebro-spinal system. Or, in 
his own words, ' two kinds of nerves are requisite for the produc- 
tion of these reflex phenomena of organic life : the first transmits 
the impression to the nervous centres ; the second, to the viscera. 
With one order of these nervous filaments is always connected a 
ganglion of the great sympathetic. Example: the lingual nerve 
transmits the impression of the taste to the nervous centres; a spe- 
cial nerve then conveys a corresponding excitation to the submax- 
illary gland ; on one of these nerves is situated a ganglion of the 
sympathetic, the submaxillary ganglion,' &c. He gives several 
illustrations of this fact, and further, appears to be of the opinion 
that this set of phenomena are identical with those occurring in the 
cerebro-spinal system of nerves denominated excito-motory by Dr. 
Marshall Hall ; but with this latter part of his paper we have 
nothing to do. It is only with that portion in which he appears to 
claim as his own, the suggestion of the theory that there does exist 
such a reflex relation between the sympathetic and the cerebro- 
spinal systems, and Bis presentation of it as an observation entirely 
new. 

"Now we are not aware of the exact length of time that these 
views have been held by physiologists ; they may be old, or, on the 
other hand, they may be of recent suggestion ; but certainly we 
cannot award to M. Bernard the merit of being the first to express 
such views in relation to the function of the sympathetic system of 
nerves ; and while we are exceedingly reluctant to refer to our own 
humble labors in connection with the brilliant discoveries of this 
most philosophic and able observer, a sense of duty to ourself, as a 
member ©f this National Association, prompts us not to allow this 
assertion to pass unchallenged. 

1 Translated by the New Orleans Medical Register. 



124: CLAIM TO PRIORITY IN DISCOVERY 

11 A reference to a paper presented by us to the Medical Society 
of Augusta, Georgia, and published in the Southern Medical and 
Surgical Journal, on the Influence of Dentition in producing Dis- 
ease, will show that this subject was fully discussed by us as early 
as June, 1850, and that the whole argument upon which our theory 
of the mode in which dentition does produce certain morbid results 
(diarrhoea, for instance) is based upon the supposed existence of such 
a reflex relation between the cerebro-spinal and ganglionic systems 
of nerves, as will be seen by the following: After referring the 
occurrence of convulsions, during dentition, to the reflex relations 
existing between certain nerves of the cerebro-spinal system, viz., 
the fifth pair as excitor, and the muscular branches of the spinal 
system as motory, we then endeavor to account for the occurrence 
of diarrhoea by establishing the existence of a similar relation 
between the cerebro-spinal and branches of the ganglionic system 
supplying the intestinal canal; which suggestions will be found 
embodied in the following extract from our essay in the June num- 
ber of the Southern Medical and Surgical Journal, for 1850, p. 329 : 
1 We have now glanced sufficiently, we think, at the anatomy and 
physiology of the sympathetic system of nerves to make the appli- 
cation of such points as are pertinent in the solution of our patho- 
logical problem. In its anatomy, we have seen its connections with 
all three of the divisions of the fifth nerve by ganglia, the connec- 
tion of these various ganglia with each other, as well as with the 
cerebro-spinal axis, and lastly, the distribution of branches from 
these ganglia, which are conducted by the arteries into every part 
of every one of the splanchnic viscera. In its physiology, we find 
it in entire charge of the important functions of nutrition and secre- 
tion, and that, wherever these processes are effected, it is by the 
agency of this nerve alone upon the bloodvessels. And further, we 
have seen that pathology and experiments upon the lower animals 
establish its indispensableness to the due performance of these 
functions, and that, whenever the supply of its innervation has 
been cut off from any particular part of the organism, that part 
immediately manifests symptoms of impaired nutrition and altered 
secretion. 

" ' Now, we are all aware that nearly the whole of the intestinal 
canal, or rather that portion between the stomach and lower part of 
the colon, receives no direct innervation from the cereDro-spinal 
axis, but is entirely dependent upon the sympathetic nerve for its 
supply of nervous influence, of whatever kind it may enjoy, whether 



OF EXCITO-SECRETORY SYSTEM OF NERVES. 125 

motory, sensoiy, or secretory, and consequently an impairment in 
the function of this nerve must, necessarily, correspondently alter 
its condition, so far as regards all those functions with which this 
nerve endows it. The alteration in these functions would, of 
course, depend, in a great degree, upon the amount of impairment 
in the source of irritation ; thus, as we have seen, if the supply be 
entirely cut off, the functions of the arteries seem, in a great mea- 
sure, to cease, passive congestions occur, and the parts inflame and 
ulcerate. Now, we can also very naturally conceive of a condition 
of these nerves somewhat analogous to the above, yet intermediate 
between the entire interruption caused by section and perfect 
health — a condition of embarrassed, or, perhaps, of exalted inner- 
vation. Now, this intermediate condition is exactly the state 
which, from the developments of the foregoing investigation, we 
feel that we are authorized to affirm, is that which occurs as the 
result of severe dentition, and that upon it is dependent the whole 
train of intestinal morbid phenomena observable during this pro- 
cess. 

" ' That this so far is legitimately inferable, we do not think any 
one will deny. Now let us inquire how far these phenomena are 
dependent upon dentition ; and analogy with the excito-motory system 
will much assist us in our argument. We have seen that local 
irritations can, through this system, produce convulsions by the 
reflex function of the nerves, the sensitive branches of the fifth 
pair becoming excitor to the motory spinal nerves ; and so, we may 
justly infer, do these same tranches (of the fifth pair), under certain 
circumstances, become excitor to the secretory filaments of the sym- 
pathetic, distributed so abundantly to the intestinal canal by a trans- 
mission of this irritation through the various ganglia with which it 
is connected. Thus, the irritation at first produces simply an exalta- 
tion of the innervation of these secretory surfaces, and consequently secre- 
tion is more active than normal, producing simple diarrhoea. A con- 
tinuance of the irritation alters the character of the secretion, and ice 
have the various morbid discharges observable during this period. This 
increase and change in the secretion are effected by the agency of the 
altered function of the nerve upon the arteries from which these 
secretions are eliminated. Now, when the innervation of these 
arteries is still further embarrassed by the long continuance of the 
reflected irritation, the state of things nearly approaches what was 
observed in Dupuy's, Eeid's, and Pourfour du Petit's experiments, 
of actual destruction of the nerve, and we have ulceration of the 
10 



126 CLAIM TO PKIORITY IN DISCOVERY 

intestinal mucous membrane ; all these phenomena being the result 
of various degrees of injury sustained by the sympathetic nerve. 
It may here be asked — why should the branches supplying the 
intestinal mucous membrane become more implicated than any 
other portion of the sympathetic system ? And why do not similar 
irritations of the fifth nerve produce like results in the adult ? To 
the first of these questions we answer, that most probably the other 
portions are implicated ; but the manifestations of such implication 
are greater and graver here than elsewhere, because these sympa- 
thetic brauches are the sole sources of innervation to the viscus. 
Other organs are in all probability affected ; but, receiving a certain 
amount of innervation from other sources, most of their functions, 
not being entirely secretory, are still, though imperfectly, carried 
on. But in the intestinal canal the case is far different ; the requisi- 
tions made upon it are of such a nature that it has need for no 
other innervation than that of. the sympathetic system. Its func- 
tions are secretion and nutrition for the whole animal organism, 
and when these are impaired, its primary, indeed, its only intents 
are altered, or completely nullified. The second question is 
answered by the greater development of this system in the grow- 
ing than in the adult individual, for the purpose of supplying the 
more active nutrition and secretion at that time necessary. We 
know that disease is more apt to occur in many parts of the body 
during this period than at other times; this is the general admis- 
sion. Thus, according to many authors, among whom are West, 
Churchill, &c, pneumonia and . bronchitis are more apt to attack 
children during dentition than at any previous or subsequent 
period. Cutaneous eruptions, and many other aberrations of secre- 
tion occurring during this period, serve to corroborate our theory 
of the origin of the morbid intestinal secretion. The increased 
vermicular action and tormina attending this affection find a ready 
explanation in the fact, now well established, that the sympathetic 
receives both motor and sensitive filaments from the anterior and 
posterior roots of the spinal nerves, endowing the organs of their 
distribution, to a certain degree, with corresponding susceptibilities. 
Ui In conclusion, let us define the position which, at the end of our 
investigation, we feel warranted in assuming. It is the following : That 
in the anatomy and physiology, as well as in the dependent analogies of 
the process of dentition, we find ample ground for the opinion that the 
diseases pertaining to this period may be dependent, and in many in- 
stances are entirely SO, UPON THE LOCAL IRRITATION ATTENDING THE 



OF EXCITO-SECRETORY SYSTEM OF NERVES. 127 

PROCESS, BEING TRANSMITTED THROUGH the cerebrospinal system of 
nerves, producing convulsive diseases in the motory apparatus, OR 
THROUGH THE SYMPATHETIC, CAUSING DERANGEMENTS OF THE 
SECRETORY ORGANS, PARTICULARLY OF THE ALIMENTARY CANAL, 
by the sway which it exercises over the arterial system from which these 
secretions are eliminated. 1 

" In the above brief quotation, it will be observed that the doc- 
trine of the reflex function between the cerebro-spinal and sympa- 
thetic systems is plainly enunciated, and not only is the physio- 
logical fact noted, but we there also have surmised the transmission 
of permanent irritation, or of paralysis from the cerebro-spinal to 
the sympathetic system, giving rise to various aberrations in nutri- 
tion and secretion. This opinion we have held for several years, teach- 
ing to our classes that there EXISTED BETWEEN THE CEREBRO-SPINAL 

and the ganglionic system of nerves a relation similar to that be- 
tween the sensitive and motor branches of the cerebro spinal, and ivhich 
Marshall Sail terms EXCITO -MOTORY; WHILE WE HAVE TERMED 
THAT BETWEEN THE CEREBRO-SPINAL AND SYMPATHETIC Systems 
EXCITO-SECRETORY. 

" As we have before indicated in this report, we do not feel 
authorized to lay full claim to the above theory without further 
investigation of the subject; but with all due courtesy to that 
highly distinguished gentleman, we can say that we feel assured 
that these views are not original with M. Bernard, unless he enter- 
tained them previous to June, 1850. There may have been other 
similar observations; but until the publication of M. Bernard's, 
we had not noticed them elsewhere than in our paper on Denti- 
tion." 

You will perceive that in the above memoir, I have introduced 
enough from the first record to constitute a pretty complete resume 
of my original announcement and process of induction. But being 
apprehensive that the doctrine of a new function so clearly and 
publicly defined, would suggest its appropriate name to some one 
before I was prepared to take up the subject again, I, on this occa- 
sion, condensed into a short paragraph, as you will see near the 
end of the paper, a comprehensive re-statement of my doctrine, and 
placing it in juxtaposition with your own distinguished name, and 
also in contradistinction to your own great analogous discovery of 
the Excito-uonoBY system, after emphasizing the word "similar" to 
indicate that I did not consider them " identical 1 '' I applied to it the 
expressive designation (now used by yourself) of excito-secre- 



128 CLAIM TO PRIORITY IN DISCOVERY 

TORY — a word never before that moment (as I believe and have above 
stated) written by any other person in any language, except by me, 
in my private notes. 

As an evidence of the importance attached to this brief commu- 
nication by the publishing committee of the Association, I call 
your attention to the fact that it is rendered conspicuous by not 
less than four references in the short index at the end of this volume 
of the Transactions. On the appearance of the volume (Vol. VI., 
1853), several of the prominent scientific periodicals made special 
reference to my claim of priority preferred against Mons. Cle. Ber- 
nard, during their review of the Transactions. I send you two of 
these, the most prominent, perhaps, now at hand : — 

From the American Journal of the Medical Sciences, January, 
1854, No. LIIL, new series, p. 135. Edited by Isaac Hays, M. D., 
Philadelphia, Pa. 

" The next article is a short paper by Dr. Henry F. Camp- 
bell, of Georgia > in which that gentleman lays claim to priority in 
the enunciation of the doctrine that there exists a reflex relationship 
between the sympathetic and the cerebro-spinal system of nerves, 
which has been recently claimed by Dr. Bernard, of Paris, as an 
observation entirely new and original with him. Dr. Campbell has 
shown that, at least, priority of publication is with him." 

The next is from the New York Journal of Medicine, new series, 
p. 254, vol. xii. No. 2, March, 1854. Edited by S. S. Purple, M.D., 
and Stephen Smith, M. D. 

" On the Sympathetic Nerve in Reflex Phenomena, by Henry F. 
Campbell, M.D., of Geo. — The design of this short article is to 
establish the precedence of the writer's enunciation of the doctrine 
of a reflex relation existing between the cerebro-spinal and gan- 
glionic system of nerves, recently put forth by M. Bernard. The 
views of Dr. Campbell are contained in a paper on the Influence of 
Dentition in producing Disease, published in the Southern Medical 
and Surgical Journal, in 1850, The author certainly establishes 
his claim to priority of publication, as far as regards Bernard's 
article referred to in the Gazette Medicate; but, if we are not mis- 
taken, similar views have been advanced at a still earlier date. As 
he does not, however, pretend to priority over all others, but only 
so far as his information extends, we will not be to the trouble of 
examining the subject further." 



OF EXCITO-SECRETORY SYSTEM OF NERVES. 129 

You will here perceive that the above claim of priority over 
Mons. Claude Bernard, in 1851, is distinctly referred to, and recog- 
nized by two of the leading medical periodicals of this country, 
both of which have exchanges in Europe, and the first especially 
circulating and being read in your country, more, probably, than 
any other American Medical journal. 

On the printing of the sixth volume of the Transactions of the 
American Medical Association, for 1853, I engaged with the pub- 
lishers to strike off extra copies, for distribution, of the Report on 
Typhoid Fever, in which memoir the principle of the Keflex Pheno- 
mena between the cerebro-spinal and ganglionic or secretory system 
of nerves is recognized, though not made a prominent feature of 
the essay. The pamphlet made up from these extra sheets was 
sent to yourself, as well as to your distinguished contemporaries, 
Drs. W. B. Carpenter, E. B. Todd, Mr. W. Bowman, and Dr. W. 
Jenner ; and more recently to Dr. T. B. Peacock, of St. Thomas's 
Hospital. 

Near the close of last year, I was solicited to become senior 
editor of the Southern Medical and Surgical Journal, and, with this 
subject ever uppermost in my thoughts, you will observe that my 
first editorial work consisted in certain strictures upon a lecture on 
" The Effects of Dentition in Nursing Children," delivered at Hotel 
Dieu, by Mons. Trousseau, of Paris, wherein I enter into a restate- 
ment of my views published in June, 1850, again bringing the two 
great facts of the nervous system into emphatic contradistinction and 
analogy, the excito-motory being indicated by the "convulsive phe- 
nomena," while the excito-secretory is instanced by the " diarrhoea" 
succeeding the local irritation in the sensitive branches of the fifth 
pair. From this I quote the following : — 

" Here, it will be observed that we have unmistakable evidences 
of local irritation of the gums, which we know are supplied by 
branches of that most exquisitely sensitive of all sensitive nerves, 
the fifth pair; if we admit the principle of reflex action, we must 
recognize here a competent cause, considering the impressible cha- 
racter of the infant's nervous system, for the convulsive phenomena. 
On the other hand, we may trace a connection between the local 
irritation and the diarrhoea succeeding it, in an analogous manner, 
taking into view the intimate connections between the fifth pair 
and the nerves of the ganglionic nervous system, from which the 
intestinal mucous surfaces receive their secretory endowments. 

" We have been thus careful (I here continue) in pointing out 

10* 



130 CLAIM TO PKIOKITY IN DISCOVERY 

the manner in which we think this local iritation may produce the 
convulsive symptoms, and also even the increased secretion from the 
mucous surface of the towels and the diarrhoea, in order to give it 
what we consider its proper amount of importance, and to direct 
attention to this as the chief source of those difficulties calling for 
early and continued care." 1 

This is my latest printed record, published in this country, as 
you will perceive, three months previously to your first; but this im- 
portant and extensive subject has never ceased to possess and stir 
my thoughts. Suggested to my mind in the first instance, by an 
accidental and trivial circumstance, occurring years ago, in the ear- 
liest days of my pupilage, 2 it became inwoven with the tissue of my 
thoughts, first, as an unpromising and tantalizing problem, it is 
true, but soon, as a broken seal — a revealed fact; and finally, as the 
familiar, self-evident truth of reflex nervous action. 

And now, dear sir, I have completed the chain of evidence which 
I find in my published records upon this, to me, momentous sub- 
ject. While it has been acknowledged on all hands that there is 
an unity in the truths of nature, it is a pleasing reflection that there 
is also an universality in the principles of science — nature's humble 
interpreter — which makes them the property of no one clime, or 
particular race of men, but parts of that vast and common treasury, 
for the benefit of all mankind. To this rapidly accumulating store, 
your own genius and unremitting energy have contributed more, 

1 Southern Medical and Surgical Journal, vol. xiii. pp. 20, 21. 

2 The "circumstance" here referred to is so illustrative of Excito-Secretory 
action, and withal so intimately connected with the origin and early history of 
the discovery, that we hope the reader will pardon us for venturing to introduce 
it here, notwithstanding its ludicrous import. It has indeed a laughable bearing, 
but it also had for us, in those early years of our reasoning, an import and a sig- 
nificance pregnant with the most serious and earnest reflections, for to them we 
owe all of whatever we have accomplished in this department of the nervous 
system. 

The case is that of a Teething Infant affected with profuse and frequent micturi- 
tion. The mother of the child, an illiterate woman, seemed fully impressed with 
the idea, that the frequent urination was dependent upon the fact that the child 
was teething ; for she said to the attending physician : " Doctor, my child is 
teething and has 'the pees vehementbf bad." — It was in the working out of this 
problem, viz., the etiological connection between these two facts, so ludicrously 
stated, that we first developed the theory of Excito-secretory action, and after- 
wards applied it to the enteric and cutaneous phenomena of Dentition. In the 
first edition of this letter to Dr. Marshall Hall, we made no particular statement of 
these earlier views, because, of course, we wished to rest our claim only upon the 
printed records. 



OF EXCITO-SECRETORY SYSTEM OF NERVES. 131 

much more, than often falls to the lot of one member of this great 
commonwealth to gather. Your name must ever be associated with 
the history of doctrines in the physiology of the nervous system, 
acknowledged and made the basis of induction in every portion of 
the scientific world. Observing you, admiring you, and studying 
you closely, can you censure me if I have wished, in some degree, 
to emulate you, and place my humble name, one day, near your 
own on the scroll of science. That day is now, I hope, about to 
arrive; you have intimated that this excito- secretory function of the 
nervous system, which, as I think, I have herein shown has been 
developed and named by me in 1850 and 1853, is a principle not 
less extensive than the excito-motory function developed and named 
by you in 1837. You have said, most truly, that it is " a vast 
subject, requiring many laborers and many years fully to develop 
that and the other sub-system." I here ask permission to express 
the wish, that as long and as usefully as you have already lived, 
you may still be spared to add much to the fuller development of 
the excito-secretory system, much more than I could ever hope alone 
to accomplish. 

Mingled with other feelings, all of which are at this moment those 
of sincere kindness, is the regret that my repeated publications on 
this subject have never reached your eye. I feel that I am not 
chargeable with having omitted to give publicity to my records, as 
the annals of the American Medical Association will plainly reveal. 
As you intend publishing shortly more in detail upon these sub- 
jects, I here earnestly and respectfully ask the honor of having my 
records meet due acknowledgment at your distinguished hands. 

And now, respected sir, I will close this already too prolonged 
communication: as courtesy to you, and justice to myself, were 
professedly the instigating causes of its inditement, I do most sin- 
cerely hope, that in the too earnest establishment of the latter, I 
have not at any moment even appeared to have forgotten the for- 
mer. 

I am, sir, with feelings of great respect, 
Your obedient servant, 

HEKKY F. CAMPBELL. 



NOTE CONCLUSORY 



In the foregoing pages, we are aware that we have advanced 
views which, if they meet general acceptation, must, to a certain 
degree, modify some of the established doctrines of the profession, 
not only with regard to pathology, but in physiology likewise. 
There is, perhaps, no one department of pathology in which so 
much valuable matter has been collected, in which such a treasury 
of facts has been laid up for data, as in the department of continued 
fevers. M. Louis, using these as the basis of his observations, added 
vastly to them, and gained an authority and command for his 
opinions, from which there was no appeal. The intestinal lesions 
of typhoid fever became to be regarded as the origin and the cause 
of all the phenomena presented by the disease — indeed, as the dis- 
ease itself, and not, as we have endeavored to show, but one of its 
manifestations. The objections to his theory, and the grounds for 
regarding these intestinal lesions and all the other phenomena of 
typhoid fever as common results of aberrant nervous action in the 
ganglionic system, have been fully presented to the reader in tbg 
second paper of this volume. By pursuing a similar line of argu- 
ment, all the various forms of those fevers which we have classed 
under the head of " Ganglionic Fevers," can be rationally traced to 
the same origin, and they will all be found to derive every one of those 
manifestations which peculiarize them as a class, from the SECRETORY 
system of nerves. It is this one great fact which constitutes the 
common basis of their classification as found in the introduction to 
the present collection. 

In relation to the discussion of the question of Priority in the 
matter of the Excito-Secretory Systerrf Dr. Marshall Hall has gene- 
rously yielded all that we claimed in regard to it; he says that it is 
undeniable that we first called attention to it, that we named it, and 
that the idea and designation belong to us ; and, further, that the 
whole ample field of the application of the Excito-secretory action 



134 NOTE CONCLUSORY. 

to Pathology, is indisputably ours. That he should give to M. 
Bernard the credit of having first demonstrated it experimentally we 
do not object ; our own conclusions were arrived at from the obser- 
vation of the results of morbid action, years before, and we were 
fully satisfied in regard to the function, and announced it plainly, 
before any experiment had been made. In the following brief ex- 
tracts from his letter to the London Lancet (May 2, 1857), will be 
found the substance of his adjudication of the question: — 

" It would be unjust to deny that Dr. Campbell has the merit of 
having first called attention to the excito-secretory sub-system, in 
the year 1850, and that he imposed this very designation in 1853. 

" So far Dr. Campbell's claims are undeniable, and I would say 
1 pal mam qui meruit ferat.' 

" I arrive at this conclusion : the idea and the designation of the 
excito-secretory action belong to Dr. Campbell, but his details are 
limited to pathology and observation. The elaborate experimental 
demonstration of reflex excito-secretory action is the result of the 
experimental labors of M. Claude Bernard. And now I say — 
1 suum cuiqne.' 

" My own claim is of a very different character, and I renounce 
every other. It consists in the vast generalization of the excito- 
secretory action throughout the system." 

"There is, perhaps, not a point in the general cutaneous surface, 
in which tetanus — an excito- motor effect — may not originate; there 
is scarcely a point in which internal inflammation — an ex.cito- 
secretory effect — may not be excited. 

• "Every point of the animal economy is in solidarite by a reflex 
excito-secretory action with every other !" 

And he thus concludes his reply to our communication : — 

"I trust Dr. Campbell will be satisfied with my adjudication. 
There is in the excito-secretory function, as applied to pathology, an 
ample field of inquiry for his life's career, and it is indisputably — 
his own. He first detected it, gave it its designation, and saw its 
vast importance. 

I am, Sir, your obedient servant, 

MARSHALL HALL. 

April, 1857." • 

The relative value of observation and experiment being a promi- 
nent theme of one of the papers in the present collection, we forbear 
to remark further upon the subject in this place. Suffice it to say, 



NOTE CONCLUSORY. 135 

that we considered the excito-secretory action sufficiently demon- 
strated from our observations long before M. Bernard ever made an 
.experiment. 



With thy name this song begun — 
With thy name thus much shall end." 

Childe Harold's Pilgrimage. 



The initial page of this volume opened with a grateful and an 
admiring dedication to Dr. Marshall Hall, and we had hoped long 
to enjoy the happiness of his encouragement and approval in our 
future labors — but this, by the inscrutable decree of Divine Wisdom, 
could not be — these closing lines must be saddened by the melancholy 
record of his death. The London Lancet of August 15, 1857, con- 
tains the following mournful intelligence: — 

"Death, that most unsparing of tyrants, has exacted from the 
greatest physiologist of the age the last debt of nature. Slowly, 
surely, and relentlessly, disease has been undermining the earthly 
tabernacle of a mind which, for vast powers, high purposes, and 
indomitable energy, has found no superior in its native land in the 
present half-century. On Tuesday last, the 11th inst., Dr. Marshall 
Hall died at Brighton, aged 67 years." 

We could easily have changed the wording of our dedication, on 
hearing of his departure, by communicating with the publishers — 
but we could not bear to make the alteration. Inscribed to Mar- 
shall Hall — the living Marshall Hall — so now Jet it remain — for, 
though he no more walks among the children of men — no longer 
solves for us, the abstruse problems of mysterious life, yet his — is 
one of those "immortal names" which will not — can not die. So far 
then from changing our dedication, we here ardently reiterate it, and 
again inscribe our humble labors, To the Living — Ever Living 
Marshall Hall! 



1 



